| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
766 |
760 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
635 |
629 |
$14K |
| D0274 |
Bitewings - four radiographic images |
638 |
633 |
$12K |
| D0330 |
Panoramic radiographic image |
274 |
270 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
710 |
705 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
198 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
475 |
469 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,169 |
679 |
$5K |
| D1120 |
Prophylaxis - child |
170 |
167 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
706 |
701 |
$3K |
| D1206 |
Topical application of fluoride varnish |
172 |
172 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
30 |
$564.50 |
| D0350 |
|
30 |
30 |
$332.37 |