| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
592 |
533 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,272 |
654 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
546 |
495 |
$16K |
| D0274 |
Bitewings - four radiographic images |
486 |
442 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
726 |
652 |
$10K |
| D0350 |
|
530 |
478 |
$8K |
| D1206 |
Topical application of fluoride varnish |
165 |
151 |
$6K |
| D1120 |
Prophylaxis - child |
119 |
111 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
101 |
98 |
$2K |
| D4355 |
|
37 |
27 |
$1K |
| D1110 |
Prophylaxis - adult |
53 |
46 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
39 |
$930.72 |