| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,911 |
1,651 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
276 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
338 |
281 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
582 |
578 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
164 |
157 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
121 |
$854.80 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
92 |
$747.95 |
| D1120 |
Prophylaxis - child |
552 |
548 |
$427.40 |
| D0220 |
Intraoral - periapical first radiographic image |
334 |
316 |
$427.40 |
| D0330 |
Panoramic radiographic image |
125 |
124 |
$213.70 |
| D1206 |
Topical application of fluoride varnish |
620 |
616 |
$106.85 |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
39 |
$106.85 |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$0.00 |
| D0180 |
|
12 |
12 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
194 |
192 |
$0.00 |