| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,111 |
1,111 |
$44K |
| D0274 |
Bitewings - four radiographic images |
986 |
986 |
$20K |
| D0330 |
Panoramic radiographic image |
477 |
477 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
321 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
217 |
202 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,020 |
1,009 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
814 |
813 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$2K |