| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
1,726 |
1,398 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
1,679 |
1,420 |
$53K |
| D1110 |
Prophylaxis - adult |
1,020 |
1,020 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,157 |
2,511 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
920 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,101 |
1,101 |
$26K |
| D5820 |
|
73 |
73 |
$17K |
| D0274 |
Bitewings - four radiographic images |
356 |
356 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
858 |
740 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
196 |
$8K |
| D2335 |
|
65 |
48 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
43 |
$4K |
| D0272 |
Bitewings - two radiographic images |
166 |
166 |
$3K |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$3K |
| D2330 |
|
28 |
12 |
$1K |