| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
668 |
529 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,256 |
1,046 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
343 |
$12K |
| D1120 |
Prophylaxis - child |
473 |
397 |
$11K |
| D0272 |
Bitewings - two radiographic images |
565 |
486 |
$8K |
| D0330 |
Panoramic radiographic image |
184 |
159 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
365 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
15 |
14 |
$396.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
13 |
$263.40 |