| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,155 |
2,124 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,019 |
1,004 |
$51K |
| D1330 |
|
2,512 |
2,471 |
$22K |
| D1110 |
Prophylaxis - adult |
968 |
950 |
$12K |
| D0330 |
Panoramic radiographic image |
1,462 |
1,443 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,672 |
3,279 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
86 |
86 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,345 |
1,322 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,825 |
1,794 |
$3K |
| D1120 |
Prophylaxis - child |
1,203 |
1,183 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,641 |
3,559 |
$3K |
| D1351 |
Sealant - per tooth |
339 |
91 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
83 |
$1K |
| D0272 |
Bitewings - two radiographic images |
514 |
503 |
$657.16 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
17 |
$560.24 |