| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
338 |
299 |
$15K |
| D0330 |
Panoramic radiographic image |
183 |
168 |
$13K |
| D1110 |
Prophylaxis - adult |
206 |
202 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
548 |
496 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
296 |
$7K |
| D0274 |
Bitewings - four radiographic images |
189 |
174 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
112 |
112 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
294 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
108 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$566.40 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$336.00 |
| D1999 |
|
293 |
206 |
$0.00 |