| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
989 |
$25K |
| D1110 |
Prophylaxis - adult |
419 |
385 |
$16K |
| D0274 |
Bitewings - four radiographic images |
130 |
120 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
197 |
176 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
41 |
$2K |
| D9110 |
|
92 |
84 |
$2K |
| D0330 |
Panoramic radiographic image |
46 |
41 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
97 |
$823.68 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$386.10 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$318.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
22 |
$263.54 |
| D9986 |
|
55 |
46 |
$0.00 |