| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
257 |
257 |
$9K |
| D0274 |
Bitewings - four radiographic images |
233 |
233 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
104 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
222 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
139 |
139 |
$3K |
| D1110 |
Prophylaxis - adult |
66 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
150 |
$732.34 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$466.90 |
| D1310 |
|
40 |
40 |
$463.52 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$192.00 |
| D1330 |
|
16 |
16 |
$184.43 |
| D1320 |
|
18 |
18 |
$57.99 |