| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,713 |
1,558 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,850 |
1,319 |
$38K |
| D1120 |
Prophylaxis - child |
751 |
678 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,230 |
1,147 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
425 |
377 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,188 |
1,104 |
$14K |
| D1351 |
Sealant - per tooth |
645 |
105 |
$13K |
| D1110 |
Prophylaxis - adult |
673 |
624 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
781 |
710 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
103 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
139 |
121 |
$3K |
| D0601 |
|
529 |
473 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$360.00 |
| D1999 |
|
13 |
13 |
$195.00 |