| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,676 |
2,661 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
2,947 |
2,930 |
$182K |
| D4341 |
|
1,950 |
524 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,808 |
1,803 |
$116K |
| D4910 |
|
1,085 |
1,081 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,925 |
3,758 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,389 |
1,383 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,716 |
2,701 |
$58K |
| D1120 |
Prophylaxis - child |
1,279 |
1,274 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,418 |
2,404 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
344 |
260 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,286 |
1,280 |
$15K |
| D9910 |
|
208 |
208 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
755 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
55 |
$5K |
| D9430 |
|
121 |
121 |
$4K |