| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
120 |
93 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
65 |
65 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
61 |
61 |
$916.98 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
31 |
$494.47 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$16.35 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
15 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$0.00 |