| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
198 |
$6K |
| D1110 |
Prophylaxis - adult |
108 |
104 |
$5K |
| D0330 |
Panoramic radiographic image |
123 |
94 |
$3K |
| D1206 |
Topical application of fluoride varnish |
213 |
196 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
117 |
97 |
$2K |
| D1120 |
Prophylaxis - child |
72 |
66 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
200 |
151 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
154 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
28 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
87 |
$1K |
| D0274 |
Bitewings - four radiographic images |
28 |
26 |
$694.98 |
| D0603 |
|
420 |
382 |
$0.00 |