| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,042 |
1,035 |
$56K |
| D1110 |
Prophylaxis - adult |
877 |
874 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,154 |
1,146 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
373 |
372 |
$8K |
| D1206 |
Topical application of fluoride varnish |
351 |
351 |
$7K |
| D1120 |
Prophylaxis - child |
148 |
147 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
111 |
105 |
$555.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
32 |
31 |
$465.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$270.96 |