| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,300 |
$15K |
| D1110 |
Prophylaxis - adult |
407 |
388 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,373 |
831 |
$12K |
| D0274 |
Bitewings - four radiographic images |
407 |
383 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
422 |
405 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
317 |
298 |
$8K |
| D0330 |
Panoramic radiographic image |
66 |
54 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$638.30 |
| D1206 |
Topical application of fluoride varnish |
17 |
15 |
$226.20 |