| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
77 |
$2K |
| D0274 |
Bitewings - four radiographic images |
65 |
64 |
$2K |
| D0330 |
Panoramic radiographic image |
57 |
56 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
85 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
78 |
$788.00 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$638.82 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$360.80 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$268.40 |