| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
264 |
261 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
316 |
$4K |
| D1120 |
Prophylaxis - child |
79 |
79 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
362 |
85 |
$2K |
| D5213 |
|
34 |
31 |
$2K |
| D1110 |
Prophylaxis - adult |
81 |
81 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
59 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
102 |
$1K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
80 |
$808.96 |
| D0272 |
Bitewings - two radiographic images |
35 |
35 |
$576.00 |
| D5899 |
|
118 |
84 |
$471.50 |
| D5410 |
|
15 |
13 |
$315.00 |
| D5110 |
|
28 |
27 |
$0.00 |
| D5214 |
|
26 |
22 |
$0.00 |