| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
981 |
850 |
$44K |
| D1206 |
Topical application of fluoride varnish |
873 |
866 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
963 |
950 |
$18K |
| D0274 |
Bitewings - four radiographic images |
454 |
448 |
$12K |
| D1120 |
Prophylaxis - child |
765 |
751 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
229 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
109 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
57 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
15 |
$322.44 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$156.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |