| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,071 |
1,017 |
$21K |
| D1120 |
Prophylaxis - child |
188 |
180 |
$8K |
| D0272 |
Bitewings - two radiographic images |
887 |
846 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
167 |
163 |
$4K |
| D0330 |
Panoramic radiographic image |
244 |
230 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
664 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
172 |
$3K |
| D1206 |
Topical application of fluoride varnish |
108 |
100 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$768.85 |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
59 |
$663.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
53 |
$604.20 |