| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
91 |
89 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$1K |
| D0274 |
Bitewings - four radiographic images |
41 |
40 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
37 |
36 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
45 |
$1K |
| D1110 |
Prophylaxis - adult |
20 |
17 |
$1K |
| D1120 |
Prophylaxis - child |
16 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44 |
42 |
$770.34 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$658.50 |