| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,531 |
1,522 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,570 |
1,567 |
$42K |
| D1110 |
Prophylaxis - adult |
625 |
624 |
$35K |
| D1120 |
Prophylaxis - child |
303 |
303 |
$13K |
| D9310 |
|
132 |
131 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
398 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
366 |
366 |
$5K |
| D0330 |
Panoramic radiographic image |
137 |
137 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
302 |
302 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
153 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
54 |
$2K |
| D0340 |
|
47 |
47 |
$2K |
| D8660 |
|
43 |
43 |
$1K |
| D0470 |
|
49 |
49 |
$1K |
| D0350 |
|
48 |
48 |
$462.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$360.00 |