| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
471 |
465 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
186 |
$10K |
| D0274 |
Bitewings - four radiographic images |
378 |
368 |
$9K |
| D0330 |
Panoramic radiographic image |
157 |
155 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
297 |
294 |
$7K |
| D1120 |
Prophylaxis - child |
154 |
154 |
$7K |
| D1110 |
Prophylaxis - adult |
85 |
84 |
$5K |
| D1206 |
Topical application of fluoride varnish |
71 |
71 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
22 |
17 |
$954.00 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
61 |
$745.38 |
| D1330 |
|
55 |
54 |
$330.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
15 |
$227.36 |