| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
869 |
720 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
377 |
346 |
$20K |
| D1206 |
Topical application of fluoride varnish |
621 |
524 |
$17K |
| D0274 |
Bitewings - four radiographic images |
980 |
768 |
$17K |
| D1351 |
Sealant - per tooth |
737 |
79 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,397 |
1,128 |
$13K |
| D1110 |
Prophylaxis - adult |
284 |
221 |
$8K |
| D1120 |
Prophylaxis - child |
198 |
183 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,545 |
1,006 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
463 |
360 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
150 |
$5K |
| D0330 |
Panoramic radiographic image |
163 |
96 |
$4K |
| D0383 |
|
101 |
27 |
$272.00 |
| D0270 |
|
12 |
12 |
$117.90 |
| D0601 |
|
32 |
29 |
$85.00 |