| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
86 |
82 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
73 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
64 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
54 |
54 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
114 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
29 |
$783.00 |
| D1206 |
Topical application of fluoride varnish |
43 |
43 |
$779.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$435.00 |
| D9995 |
|
69 |
69 |
$54.00 |
| D0603 |
|
229 |
228 |
$1.77 |
| D1310 |
|
292 |
289 |
$0.07 |
| D1330 |
|
306 |
303 |
$0.00 |