| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,655 |
2,653 |
$226K |
| D0120 |
Periodic oral evaluation - established patient |
2,705 |
2,702 |
$158K |
| D4341 |
|
1,772 |
474 |
$124K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,651 |
4,462 |
$109K |
| D9110 |
|
1,411 |
1,394 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,252 |
1,250 |
$78K |
| D0272 |
Bitewings - two radiographic images |
4,062 |
4,053 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,451 |
3,448 |
$45K |
| D1120 |
Prophylaxis - child |
1,000 |
1,000 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,400 |
2,043 |
$28K |
| D1351 |
Sealant - per tooth |
1,001 |
176 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
65 |
$11K |
| D1206 |
Topical application of fluoride varnish |
418 |
418 |
$6K |
| D7111 |
|
29 |
13 |
$2K |
| D9430 |
|
12 |
12 |
$384.00 |