| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
4,233 |
3,713 |
$212K |
| D1110 |
Prophylaxis - adult |
1,781 |
1,764 |
$96K |
| D1354 |
|
1,666 |
337 |
$66K |
| D1206 |
Topical application of fluoride varnish |
1,554 |
1,537 |
$58K |
| D0190 |
|
1,902 |
1,899 |
$37K |
| D1330 |
|
2,348 |
2,323 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
182 |
$16K |
| D9920 |
|
742 |
739 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
411 |
410 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
392 |
392 |
$8K |
| D4910 |
|
77 |
77 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
76 |
$4K |
| D0191 |
|
145 |
145 |
$3K |
| D0274 |
Bitewings - four radiographic images |
34 |
34 |
$1K |
| D1355 |
|
29 |
14 |
$800.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$741.00 |
| D9910 |
|
24 |
24 |
$528.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$288.00 |