| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
8,183 |
6,683 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,440 |
1,333 |
$969.92 |
| D0210 |
Intraoral - complete series of radiographic images |
900 |
844 |
$862.54 |
| D1110 |
Prophylaxis - adult |
2,546 |
2,275 |
$337.92 |
| D0220 |
Intraoral - periapical first radiographic image |
398 |
388 |
$37.92 |
| D0230 |
Intraoral - periapical each additional radiographic image |
815 |
429 |
$20.32 |
| D0274 |
Bitewings - four radiographic images |
23 |
23 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,124 |
1,003 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,847 |
1,784 |
$0.00 |
| D4999 |
|
194 |
141 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
321 |
237 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$0.00 |