| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
6,513 |
5,691 |
$1.38M |
| D1110 |
Prophylaxis - adult |
1,497 |
1,440 |
$11K |
| D0330 |
Panoramic radiographic image |
1,052 |
1,008 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,093 |
1,058 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
545 |
504 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
2,729 |
2,632 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,038 |
1,000 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
461 |
432 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
383 |
328 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
86 |
$519.12 |
| D1120 |
Prophylaxis - child |
2,151 |
2,070 |
$247.50 |
| D0272 |
Bitewings - two radiographic images |
935 |
901 |
$234.56 |
| D1206 |
Topical application of fluoride varnish |
3,404 |
3,288 |
$161.70 |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
65 |
$14.70 |
| D0602 |
|
2,261 |
2,221 |
$0.00 |
| D0601 |
|
37 |
37 |
$0.00 |
| D0603 |
|
1,881 |
1,831 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,168 |
539 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
201 |
201 |
$0.00 |