| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
413 |
386 |
$6K |
| D0330 |
Panoramic radiographic image |
138 |
134 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
128 |
$5K |
| D0274 |
Bitewings - four radiographic images |
184 |
176 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
551 |
383 |
$3K |
| D1206 |
Topical application of fluoride varnish |
74 |
70 |
$2K |
| D1120 |
Prophylaxis - child |
38 |
36 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
29 |
28 |
$934.30 |
| D0190 |
|
12 |
12 |
$164.45 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$122.88 |