| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
698 |
638 |
$8K |
| D0274 |
Bitewings - four radiographic images |
310 |
287 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
847 |
532 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
195 |
182 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
95 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
64 |
62 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$589.40 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$385.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$335.00 |