| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
2,725 |
1,974 |
$447K |
| D0120 |
Periodic oral evaluation - established patient |
833 |
820 |
$510.69 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,705 |
750 |
$278.95 |
| D1110 |
Prophylaxis - adult |
297 |
297 |
$214.03 |
| D0220 |
Intraoral - periapical first radiographic image |
815 |
797 |
$196.46 |
| D0274 |
Bitewings - four radiographic images |
462 |
456 |
$164.06 |
| D1120 |
Prophylaxis - child |
307 |
304 |
$110.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
444 |
$88.20 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
143 |
$80.30 |
| D0272 |
Bitewings - two radiographic images |
151 |
151 |
$46.76 |
| D0330 |
Panoramic radiographic image |
68 |
66 |
$0.00 |
| D0602 |
|
644 |
633 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
305 |
296 |
$0.00 |
| D0603 |
|
167 |
166 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
46 |
$0.00 |