| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
516 |
$19K |
| D1206 |
Topical application of fluoride varnish |
780 |
777 |
$15K |
| D1110 |
Prophylaxis - adult |
306 |
302 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
228 |
228 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
367 |
338 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
252 |
169 |
$3K |
| D0603 |
|
301 |
298 |
$3K |
| D0274 |
Bitewings - four radiographic images |
103 |
103 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
109 |
107 |
$3K |
| D4341 |
|
27 |
12 |
$2K |
| D1330 |
|
161 |
158 |
$1K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$960.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$676.00 |
| D0601 |
|
26 |
26 |
$264.00 |
| D1999 |
|
668 |
520 |
$0.00 |