| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,635 |
6,551 |
$230K |
| D0120 |
Periodic oral evaluation - established patient |
8,390 |
8,314 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,602 |
2,589 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,856 |
3,831 |
$75K |
| D5110 |
|
107 |
101 |
$52K |
| D5120 |
|
69 |
67 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
429 |
196 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
373 |
$3K |
| D1330 |
|
392 |
387 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
469 |
179 |
$2K |
| D5411 |
|
90 |
90 |
$2K |
| D0274 |
Bitewings - four radiographic images |
57 |
57 |
$2K |
| D5410 |
|
12 |
12 |
$220.00 |
| D9932 |
|
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| D5899 |
|
26 |
26 |
$0.00 |