| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
8,883 |
2,599 |
$627K |
| D0160 |
|
5,345 |
4,845 |
$226K |
| D0210 |
Intraoral - complete series of radiographic images |
4,916 |
4,457 |
$192K |
| D4355 |
|
2,517 |
2,289 |
$148K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,900 |
601 |
$123K |
| D4910 |
|
2,191 |
2,041 |
$94K |
| D1110 |
Prophylaxis - adult |
2,664 |
2,499 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,510 |
2,353 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,455 |
2,287 |
$36K |
| D4342 |
|
1,099 |
383 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,086 |
1,030 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
906 |
807 |
$16K |
| D0170 |
|
744 |
670 |
$11K |
| D1120 |
Prophylaxis - child |
479 |
442 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
96 |
$629.61 |