| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
23,215 |
17,691 |
$637K |
| D1110 |
Prophylaxis - adult |
5,951 |
5,936 |
$494K |
| D0120 |
Periodic oral evaluation - established patient |
2,894 |
2,886 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,077 |
2,072 |
$126K |
| D4910 |
|
1,243 |
1,238 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,949 |
5,931 |
$80K |
| D4341 |
|
485 |
176 |
$45K |
| D5750 |
|
199 |
199 |
$39K |
| D5751 |
|
149 |
149 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,841 |
1,443 |
$28K |
| D9110 |
|
359 |
327 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,515 |
1,450 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
353 |
353 |
$16K |
| D5410 |
|
438 |
437 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
168 |
$11K |
| D5411 |
|
281 |
279 |
$9K |
| D5850 |
|
119 |
119 |
$8K |
| D0274 |
Bitewings - four radiographic images |
355 |
354 |
$7K |
| D5851 |
|
94 |
94 |
$7K |
| D9430 |
|
223 |
205 |
$6K |
| D5422 |
|
16 |
16 |
$525.00 |
| D1204 |
|
87 |
87 |
$0.00 |