| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
154 |
152 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
208 |
208 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
587 |
$3K |
| D1110 |
Prophylaxis - adult |
80 |
78 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
132 |
132 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
96 |
91 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
275 |
245 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
57 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
47 |
$948.36 |
| D0274 |
Bitewings - four radiographic images |
49 |
47 |
$553.00 |
| D0603 |
|
176 |
175 |
$0.00 |