| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
423 |
422 |
$18K |
| D9310 |
|
262 |
262 |
$15K |
| D0330 |
Panoramic radiographic image |
278 |
277 |
$9K |
| D0274 |
Bitewings - four radiographic images |
266 |
264 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
327 |
318 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
84 |
84 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
265 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
48 |
48 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$707.07 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$178.40 |
| D1320 |
|
15 |
15 |
$116.00 |