| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
145 |
112 |
$3K |
| D0274 |
Bitewings - four radiographic images |
134 |
103 |
$2K |
| D0330 |
Panoramic radiographic image |
90 |
65 |
$2K |
| D1110 |
Prophylaxis - adult |
49 |
37 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
107 |
$838.32 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
24 |
$622.05 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
15 |
$219.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
27 |
$170.80 |