| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
218 |
200 |
$3K |
| D1110 |
Prophylaxis - adult |
113 |
107 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
133 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
366 |
338 |
$3K |
| D1120 |
Prophylaxis - child |
141 |
127 |
$2K |
| D1206 |
Topical application of fluoride varnish |
211 |
193 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
163 |
150 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
370 |
311 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
55 |
$980.39 |
| D0272 |
Bitewings - two radiographic images |
67 |
60 |
$749.06 |
| D1999 |
|
295 |
260 |
$0.00 |