| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
999 |
972 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,077 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,170 |
1,048 |
$10K |
| D0330 |
Panoramic radiographic image |
292 |
278 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
125 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
229 |
223 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
429 |
415 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
137 |
$3K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$789.68 |
| D1120 |
Prophylaxis - child |
14 |
13 |
$440.25 |
| D0601 |
|
210 |
202 |
$72.35 |
| D0602 |
|
27 |
27 |
$0.05 |
| D0603 |
|
161 |
159 |
$0.00 |