| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
28,721 |
25,694 |
$6.31M |
| D1208 |
Topical application of fluoride, excluding varnish |
3,840 |
3,719 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
7,364 |
7,049 |
$6K |
| D1120 |
Prophylaxis - child |
3,363 |
3,296 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,906 |
1,895 |
$772.50 |
| D0274 |
Bitewings - four radiographic images |
3,020 |
2,985 |
$22.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,555 |
1,330 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
210 |
210 |
$0.00 |
| D1351 |
Sealant - per tooth |
533 |
152 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
4,138 |
3,920 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,053 |
1,053 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
25 |
$0.00 |
| D2331 |
|
14 |
12 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
391 |
391 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,607 |
1,311 |
$0.00 |
| D0330 |
Panoramic radiographic image |
885 |
884 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,679 |
1,670 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,200 |
1,189 |
$0.00 |
| D2999 |
|
801 |
639 |
$0.00 |