| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
17,179 |
13,565 |
$3.83M |
| D1110 |
Prophylaxis - adult |
1,388 |
1,234 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,848 |
3,461 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
468 |
409 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
1,168 |
1,060 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,423 |
1,277 |
$7K |
| D1120 |
Prophylaxis - child |
178 |
149 |
$4K |
| D1206 |
Topical application of fluoride varnish |
197 |
167 |
$3K |
| D0274 |
Bitewings - four radiographic images |
323 |
294 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
200 |
193 |
$1K |
| D4910 |
|
286 |
286 |
$700.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
27 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$0.00 |