| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,403 |
3,395 |
$134K |
| D0330 |
Panoramic radiographic image |
1,786 |
1,780 |
$68K |
| D1110 |
Prophylaxis - adult |
1,281 |
1,278 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,882 |
1,882 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
508 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,974 |
2,935 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
3,266 |
3,236 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
964 |
964 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
226 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
130 |
130 |
$4K |
| D1206 |
Topical application of fluoride varnish |
97 |
97 |
$1K |
| D0180 |
|
52 |
52 |
$1K |