| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
562 |
532 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
199 |
$4K |
| D0330 |
Panoramic radiographic image |
130 |
121 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
144 |
$3K |
| D0274 |
Bitewings - four radiographic images |
268 |
251 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
86 |
$870.72 |
| D0220 |
Intraoral - periapical first radiographic image |
177 |
158 |
$796.50 |
| D0272 |
Bitewings - two radiographic images |
75 |
72 |
$780.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$316.00 |