| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
560 |
493 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
371 |
320 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
47 |
$3K |
| D1110 |
Prophylaxis - adult |
60 |
57 |
$3K |
| D0274 |
Bitewings - four radiographic images |
93 |
86 |
$2K |
| D1206 |
Topical application of fluoride varnish |
98 |
92 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
39 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$605.28 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
17 |
$445.20 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D0431 |
|
59 |
55 |
$0.00 |
| D1999 |
|
20 |
16 |
$0.00 |