| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,932 |
1,822 |
$390K |
| D1330 |
|
523 |
498 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
210 |
202 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
666 |
640 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
499 |
473 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
178 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
181 |
172 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
84 |
$0.00 |
| D0330 |
Panoramic radiographic image |
67 |
63 |
$0.00 |
| D1120 |
Prophylaxis - child |
527 |
505 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
62 |
$0.00 |
| D1110 |
Prophylaxis - adult |
194 |
182 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
200 |
194 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
137 |
$0.00 |