| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,171 |
1,171 |
$75K |
| D0350 |
|
1,777 |
977 |
$17K |
| D0274 |
Bitewings - four radiographic images |
617 |
617 |
$12K |
| D9430 |
|
375 |
373 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,767 |
974 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
161 |
161 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
217 |
217 |
$8K |
| D1206 |
Topical application of fluoride varnish |
325 |
325 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$6K |
| D1120 |
Prophylaxis - child |
127 |
127 |
$5K |
| D1110 |
Prophylaxis - adult |
52 |
52 |
$4K |
| D0330 |
Panoramic radiographic image |
167 |
167 |
$4K |
| D1320 |
|
334 |
334 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
295 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
14 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
127 |
127 |
$1K |