| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
867 |
853 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
838 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
758 |
615 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
378 |
375 |
$7K |
| D2160 |
|
204 |
75 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
297 |
289 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
418 |
416 |
$3K |
| D0274 |
Bitewings - four radiographic images |
334 |
323 |
$2K |
| D4341 |
|
32 |
15 |
$1K |
| D2140 |
|
49 |
24 |
$900.00 |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
183 |
$839.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
140 |
$489.00 |
| D9920 |
|
34 |
32 |
$350.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$243.25 |
| D2332 |
|
44 |
13 |
$0.00 |