| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
11,490 |
9,230 |
$668K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,257 |
3,736 |
$141K |
| D1110 |
Prophylaxis - adult |
2,089 |
1,833 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,310 |
1,986 |
$47K |
| D0250 |
|
1,789 |
1,393 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
422 |
364 |
$20K |
| D7250 |
|
137 |
47 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
818 |
312 |
$8K |
| D1206 |
Topical application of fluoride varnish |
2,017 |
1,760 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
374 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
138 |
$5K |
| D5110 |
|
37 |
21 |
$4K |
| D5120 |
|
33 |
19 |
$4K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
24 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
13 |
$2K |
| D1354 |
|
203 |
74 |
$1K |
| D0251 |
|
642 |
396 |
$0.00 |
| D9996 |
|
14 |
14 |
$0.00 |
| D0260 |
|
99 |
59 |
$0.00 |