| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
707 |
667 |
$24K |
| D5110 |
|
21 |
14 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
97 |
$8K |
| D0330 |
Panoramic radiographic image |
166 |
162 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
195 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
359 |
$6K |
| D4341 |
|
54 |
16 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
469 |
120 |
$5K |
| D1110 |
Prophylaxis - adult |
58 |
58 |
$3K |
| D1120 |
Prophylaxis - child |
61 |
61 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
95 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
50 |
50 |
$1K |
| D0180 |
|
27 |
25 |
$1K |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$1K |
| D9986 |
|
63 |
63 |
$0.00 |