| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
307 |
291 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
324 |
288 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
205 |
189 |
$9K |
| D0603 |
|
83 |
81 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
139 |
128 |
$5K |
| D0602 |
|
66 |
60 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
38 |
24 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
309 |
304 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$215.28 |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$107.64 |
| D1206 |
Topical application of fluoride varnish |
151 |
151 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
141 |
141 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
167 |
$0.00 |