| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,560 |
1,543 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,531 |
1,524 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
781 |
197 |
$90K |
| D9430 |
|
2,710 |
2,181 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,521 |
1,511 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,245 |
2,216 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,751 |
1,357 |
$27K |
| D2394 |
|
189 |
120 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
217 |
211 |
$14K |
| D2335 |
|
127 |
63 |
$14K |
| D1120 |
Prophylaxis - child |
261 |
260 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
826 |
791 |
$10K |
| D2940 |
|
18 |
16 |
$945.00 |
| D5851 |
|
12 |
12 |
$840.00 |
| D5850 |
|
12 |
12 |
$770.00 |
| D1999 |
|
13 |
13 |
$0.00 |