| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
846 |
839 |
$46K |
| D1110 |
Prophylaxis - adult |
713 |
710 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,016 |
1,006 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
478 |
475 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
646 |
642 |
$2K |
| D1330 |
|
752 |
748 |
$276.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
25 |
$25.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$0.00 |