| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
220 |
186 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
355 |
$5K |
| D1110 |
Prophylaxis - adult |
172 |
146 |
$5K |
| D0274 |
Bitewings - four radiographic images |
136 |
117 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
85 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
144 |
$940.80 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
24 |
$651.45 |
| D0120 |
Periodic oral evaluation - established patient |
21 |
17 |
$249.12 |
| D1999 |
|
460 |
309 |
$0.00 |