| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,981 |
7,820 |
$1.06M |
| D0120 |
Periodic oral evaluation - established patient |
1,842 |
1,764 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,387 |
3,322 |
$11K |
| D1110 |
Prophylaxis - adult |
732 |
706 |
$2K |
| D1120 |
Prophylaxis - child |
3,074 |
2,979 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
240 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,932 |
2,829 |
$988.00 |
| D0140 |
Limited oral evaluation - problem focused |
540 |
505 |
$861.46 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
146 |
$432.97 |
| D0210 |
Intraoral - complete series of radiographic images |
1,143 |
1,124 |
$388.31 |
| D0274 |
Bitewings - four radiographic images |
1,147 |
1,112 |
$310.28 |
| D0220 |
Intraoral - periapical first radiographic image |
1,102 |
1,061 |
$31.03 |
| D0230 |
Intraoral - periapical each additional radiographic image |
313 |
312 |
$22.40 |
| D4341 |
|
21 |
13 |
$0.00 |
| 1160F |
|
30 |
29 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
185 |
184 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
245 |
238 |
$0.00 |
| D0602 |
|
17 |
17 |
$0.00 |
| D1351 |
Sealant - per tooth |
44 |
17 |
$0.00 |
| 1126F |
|
16 |
15 |
$0.00 |