| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
675 |
547 |
$11K |
| D0330 |
Panoramic radiographic image |
108 |
101 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
141 |
$8K |
| D0274 |
Bitewings - four radiographic images |
259 |
206 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
751 |
320 |
$8K |
| D1110 |
Prophylaxis - adult |
226 |
169 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
112 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
72 |
59 |
$6K |
| D1999 |
|
41 |
27 |
$1K |
| D1206 |
Topical application of fluoride varnish |
103 |
84 |
$698.49 |
| D1120 |
Prophylaxis - child |
44 |
41 |
$341.86 |
| D1330 |
|
80 |
50 |
$0.00 |