| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,052 |
459 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
766 |
749 |
$10K |
| D0274 |
Bitewings - four radiographic images |
346 |
333 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
307 |
$8K |
| D1110 |
Prophylaxis - adult |
154 |
150 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
505 |
$6K |
| D1120 |
Prophylaxis - child |
152 |
148 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
114 |
$4K |
| D1351 |
Sealant - per tooth |
158 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$303.94 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$225.32 |
| D0603 |
|
1,048 |
1,023 |
$0.00 |
| D1330 |
|
36 |
30 |
$0.00 |