| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
11,635 |
10,741 |
$2.28M |
| D1206 |
Topical application of fluoride varnish |
1,778 |
1,760 |
$12K |
| D1120 |
Prophylaxis - child |
781 |
770 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,257 |
1,239 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,156 |
1,116 |
$2K |
| D1330 |
|
261 |
252 |
$558.00 |
| D1110 |
Prophylaxis - adult |
1,497 |
1,430 |
$440.00 |
| D0274 |
Bitewings - four radiographic images |
1,600 |
1,533 |
$279.00 |
| D0330 |
Panoramic radiographic image |
1,009 |
968 |
$253.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,810 |
1,752 |
$126.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,371 |
1,329 |
$108.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
210 |
163 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
491 |
188 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
214 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
192 |
183 |
$0.00 |