| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
205 |
174 |
$16K |
| D1110 |
Prophylaxis - adult |
185 |
155 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
199 |
170 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
188 |
152 |
$7K |
| D0274 |
Bitewings - four radiographic images |
31 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
47 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
36 |
$928.34 |
| D1206 |
Topical application of fluoride varnish |
36 |
30 |
$712.50 |