| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
279 |
181 |
$10K |
| D1110 |
Prophylaxis - adult |
411 |
255 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
255 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
393 |
250 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
374 |
226 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
477 |
315 |
$4K |
| D0274 |
Bitewings - four radiographic images |
114 |
82 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
120 |
106 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
184 |
89 |
$1K |
| D0330 |
Panoramic radiographic image |
38 |
29 |
$481.98 |