| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
6,629 |
6,312 |
$1.69M |
| D1206 |
Topical application of fluoride varnish |
871 |
861 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,276 |
1,242 |
$3K |
| D1120 |
Prophylaxis - child |
1,161 |
1,152 |
$2K |
| D0330 |
Panoramic radiographic image |
847 |
827 |
$784.00 |
| D1110 |
Prophylaxis - adult |
720 |
719 |
$697.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
930 |
$529.00 |
| D0274 |
Bitewings - four radiographic images |
780 |
760 |
$528.00 |
| D0272 |
Bitewings - two radiographic images |
261 |
257 |
$225.00 |
| D1330 |
|
962 |
954 |
$18.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,218 |
1,214 |
$0.00 |
| D1351 |
Sealant - per tooth |
235 |
36 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
109 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
477 |
475 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
270 |
140 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
51 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
680 |
674 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
221 |
157 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
44 |
$0.00 |