| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
780 |
560 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
605 |
448 |
$11K |
| D1110 |
Prophylaxis - adult |
297 |
225 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
343 |
233 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
452 |
343 |
$2K |
| D0272 |
Bitewings - two radiographic images |
881 |
646 |
$2K |
| D1120 |
Prophylaxis - child |
31 |
27 |
$520.00 |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
148 |
$290.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
12 |
$55.00 |