| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,404 |
8,396 |
$194K |
| D0191 |
|
13,165 |
13,154 |
$194K |
| D9310 |
|
4,057 |
4,056 |
$121K |
| D4355 |
|
2,692 |
2,692 |
$120K |
| D5110 |
|
322 |
322 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
6,574 |
6,409 |
$104K |
| D5120 |
|
219 |
219 |
$78K |
| D0210 |
Intraoral - complete series of radiographic images |
1,739 |
1,736 |
$47K |
| D1354 |
|
3,201 |
1,133 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,219 |
1,219 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
232 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
678 |
678 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,440 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
220 |
98 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,499 |
786 |
$5K |
| D9410 |
|
18,174 |
17,772 |
$0.00 |
| D9933 |
|
532 |
532 |
$0.00 |
| D9932 |
|
970 |
969 |
$0.00 |
| D9110 |
|
43 |
43 |
$0.00 |
| D0350 |
|
30 |
30 |
$0.00 |
| D9935 |
|
13 |
13 |
$0.00 |
| D1330 |
|
4,094 |
4,090 |
$0.00 |
| D9920 |
|
36 |
36 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$0.00 |