| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
225 |
218 |
$9K |
| D1110 |
Prophylaxis - adult |
87 |
81 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
259 |
$2K |
| D0274 |
Bitewings - four radiographic images |
319 |
312 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
335 |
$310.89 |
| D1120 |
Prophylaxis - child |
31 |
31 |
$310.30 |
| D1330 |
|
239 |
234 |
$177.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
46 |
45 |
$99.59 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
131 |
$0.00 |