| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
153 |
145 |
$6K |
| D1110 |
Prophylaxis - adult |
114 |
114 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
84 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
107 |
$3K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
88 |
87 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
81 |
81 |
$2K |
| D1206 |
Topical application of fluoride varnish |
47 |
47 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
114 |
$318.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$143.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
25 |
$68.00 |