| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
975 |
960 |
$34K |
| D0330 |
Panoramic radiographic image |
396 |
389 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
341 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
164 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
292 |
$5K |
| D1110 |
Prophylaxis - adult |
295 |
294 |
$788.40 |
| D0140 |
Limited oral evaluation - problem focused |
281 |
276 |
$663.93 |
| D0274 |
Bitewings - four radiographic images |
625 |
614 |
$127.94 |
| D1330 |
|
543 |
538 |
$53.84 |
| D1208 |
Topical application of fluoride, excluding varnish |
253 |
253 |
$41.84 |
| D1120 |
Prophylaxis - child |
24 |
24 |
$40.32 |
| D0220 |
Intraoral - periapical first radiographic image |
1,035 |
1,019 |
$0.00 |
| D9986 |
|
101 |
98 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
91 |
91 |
$0.00 |