| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
149 |
149 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
137 |
137 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
147 |
$2K |
| D1120 |
Prophylaxis - child |
102 |
102 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
31 |
$2K |
| D0330 |
Panoramic radiographic image |
42 |
40 |
$1K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
35 |
$767.72 |
| D0220 |
Intraoral - periapical first radiographic image |
85 |
84 |
$420.00 |