| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
406 |
338 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
262 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
95 |
$2K |
| D1110 |
Prophylaxis - adult |
397 |
318 |
$2K |
| D0330 |
Panoramic radiographic image |
135 |
109 |
$1K |
| D0274 |
Bitewings - four radiographic images |
373 |
303 |
$645.57 |
| D1330 |
|
281 |
239 |
$86.58 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$0.00 |
| D1999 |
|
19 |
17 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
279 |
238 |
$0.00 |