| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
605 |
549 |
$68K |
| D1120 |
Prophylaxis - child |
556 |
523 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
130 |
130 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
89 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
144 |
127 |
$3K |
| D1206 |
Topical application of fluoride varnish |
386 |
283 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$0.00 |
| D1351 |
Sealant - per tooth |
42 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$0.00 |