| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,729 |
1,153 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,017 |
966 |
$22K |
| D0330 |
Panoramic radiographic image |
457 |
439 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,513 |
1,409 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
448 |
419 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
414 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
130 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
311 |
279 |
$6K |
| D1206 |
Topical application of fluoride varnish |
93 |
83 |
$3K |
| D1351 |
Sealant - per tooth |
145 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
46 |
40 |
$2K |
| D9992 |
|
103 |
92 |
$0.00 |