| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,328 |
1,086 |
$192K |
| D1120 |
Prophylaxis - child |
664 |
458 |
$12K |
| T1015 |
Clinic visit/encounter, all-inclusive |
788 |
645 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,069 |
780 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
337 |
$7K |
| D1206 |
Topical application of fluoride varnish |
697 |
462 |
$5K |
| D1110 |
Prophylaxis - adult |
555 |
453 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
45 |
$2K |
| D0274 |
Bitewings - four radiographic images |
190 |
143 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
24 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
44 |
$695.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
12 |
$643.00 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
12 |
$385.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
14 |
$0.00 |
| D1330 |
|
61 |
40 |
$0.00 |