| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,346 |
3,113 |
$434K |
| D0140 |
Limited oral evaluation - problem focused |
610 |
598 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
223 |
223 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
852 |
852 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
411 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
98 |
98 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
78 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
24 |
$0.00 |
| D1120 |
Prophylaxis - child |
516 |
516 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
573 |
573 |
$0.00 |
| D0330 |
Panoramic radiographic image |
354 |
354 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
579 |
$0.00 |
| D1110 |
Prophylaxis - adult |
71 |
71 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$0.00 |