| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
4,080 |
3,334 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,420 |
4,318 |
$123K |
| D1120 |
Prophylaxis - child |
5,392 |
4,308 |
$108K |
| D0140 |
Limited oral evaluation - problem focused |
2,255 |
1,863 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,356 |
4,256 |
$60K |
| D1351 |
Sealant - per tooth |
1,950 |
245 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,802 |
2,952 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
385 |
234 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
854 |
671 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
192 |
178 |
$4K |