| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
459 |
457 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
180 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
84 |
$4K |
| D1110 |
Prophylaxis - adult |
86 |
86 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
125 |
125 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
371 |
195 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
235 |
233 |
$630.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
32 |
$480.00 |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$231.60 |