| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
2,053 |
1,267 |
$27K |
| D1120 |
Prophylaxis - child |
978 |
969 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,206 |
1,196 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,127 |
1,118 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,430 |
1,405 |
$16K |
| D0330 |
Panoramic radiographic image |
221 |
205 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
316 |
289 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
129 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
120 |
$2K |
| D1110 |
Prophylaxis - adult |
40 |
39 |
$1K |