| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
6,947 |
6,145 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,531 |
2,525 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
2,170 |
2,165 |
$111K |
| D4355 |
|
965 |
964 |
$67K |
| D1110 |
Prophylaxis - adult |
567 |
567 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,609 |
1,374 |
$40K |
| D4910 |
|
375 |
374 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,362 |
1,360 |
$16K |
| D4341 |
|
183 |
58 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
14 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
13 |
$2K |
| D9110 |
|
12 |
12 |
$696.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$170.00 |