| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
233 |
231 |
$8K |
| D1110 |
Prophylaxis - adult |
236 |
233 |
$7K |
| D0274 |
Bitewings - four radiographic images |
330 |
325 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
142 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
108 |
$2K |
| D0191 |
|
113 |
112 |
$1K |
| D9110 |
|
31 |
30 |
$652.32 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$532.39 |
| D0120 |
Periodic oral evaluation - established patient |
31 |
31 |
$525.10 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$370.94 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$99.57 |