| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
328 |
305 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
987 |
862 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
399 |
389 |
$950.71 |
| D1208 |
Topical application of fluoride, excluding varnish |
241 |
219 |
$760.93 |
| D1120 |
Prophylaxis - child |
129 |
124 |
$724.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
547 |
466 |
$615.15 |
| D1110 |
Prophylaxis - adult |
104 |
101 |
$437.89 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
35 |
$68.88 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
34 |
$60.33 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$48.49 |