| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,381 |
1,141 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
951 |
699 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
189 |
$7K |
| D0274 |
Bitewings - four radiographic images |
122 |
122 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
45 |
38 |
$892.30 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$637.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
48 |
$561.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$484.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$200.00 |
| D1330 |
|
126 |
125 |
$0.00 |