| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,126 |
1,118 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
873 |
873 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
179 |
67 |
$14K |
| D4341 |
|
126 |
43 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,308 |
1,297 |
$6K |
| D9310 |
|
339 |
325 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,584 |
1,117 |
$6K |
| D0272 |
Bitewings - two radiographic images |
598 |
598 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
97 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
92 |
$2K |
| D0180 |
|
38 |
38 |
$1K |
| D0274 |
Bitewings - four radiographic images |
94 |
94 |
$1K |