| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
433 |
425 |
$15K |
| D0274 |
Bitewings - four radiographic images |
481 |
478 |
$14K |
| D1110 |
Prophylaxis - adult |
223 |
222 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
817 |
799 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
710 |
446 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
299 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
111 |
$3K |
| D1120 |
Prophylaxis - child |
93 |
93 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$527.10 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
12 |
$466.74 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$353.70 |