| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,688 |
1,678 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,375 |
1,372 |
$84K |
| D1110 |
Prophylaxis - adult |
716 |
714 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
931 |
928 |
$42K |
| D1120 |
Prophylaxis - child |
1,082 |
1,077 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,853 |
1,991 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,208 |
2,196 |
$31K |
| D0330 |
Panoramic radiographic image |
976 |
976 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,305 |
1,294 |
$25K |
| D0350 |
|
1,665 |
460 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
12 |
$4K |
| D4341 |
|
42 |
13 |
$3K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$555.00 |
| D9430 |
|
12 |
12 |
$376.00 |