| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
30,019 |
25,199 |
$4.46M |
| D0120 |
Periodic oral evaluation - established patient |
9,365 |
9,185 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
592 |
$8K |
| T1015 |
Clinic visit/encounter, all-inclusive |
257 |
234 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,996 |
10,502 |
$5K |
| D0274 |
Bitewings - four radiographic images |
2,786 |
2,734 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
10,881 |
10,619 |
$3K |
| D1110 |
Prophylaxis - adult |
1,208 |
1,190 |
$2K |
| D0330 |
Panoramic radiographic image |
223 |
222 |
$905.47 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
26 |
$521.74 |
| D1120 |
Prophylaxis - child |
4,539 |
4,492 |
$110.25 |
| D1206 |
Topical application of fluoride varnish |
7,477 |
7,383 |
$0.77 |
| D0601 |
|
1,795 |
1,783 |
$0.00 |
| D1330 |
|
7,487 |
7,407 |
$0.00 |
| D0603 |
|
8,563 |
8,394 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,831 |
3,791 |
$0.00 |
| D0602 |
|
3,684 |
3,668 |
$0.00 |
| D1310 |
|
1,814 |
1,799 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,169 |
367 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
3,863 |
3,823 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
15 |
$0.00 |