| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
795 |
667 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
266 |
237 |
$36.00 |
| D0120 |
Periodic oral evaluation - established patient |
305 |
271 |
$26.00 |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
118 |
$11.30 |
| D1330 |
|
329 |
292 |
$0.00 |
| D0603 |
|
530 |
465 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
206 |
179 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
189 |
154 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
40 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
33 |
32 |
$0.00 |