| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
939 |
689 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
732 |
559 |
$18K |
| D1120 |
Prophylaxis - child |
460 |
290 |
$11K |
| D1206 |
Topical application of fluoride varnish |
304 |
223 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
249 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
68 |
$2K |
| D0274 |
Bitewings - four radiographic images |
79 |
52 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
66 |
48 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
77 |
$600.78 |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
16 |
$480.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$260.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
15 |
$143.36 |
| D0603 |
|
106 |
53 |
$49.00 |