| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,115 |
996 |
$221K |
| D1206 |
Topical application of fluoride varnish |
782 |
703 |
$0.00 |
| D0240 |
|
690 |
305 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
48 |
48 |
$0.00 |
| D0603 |
|
772 |
715 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
263 |
238 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
488 |
434 |
$0.00 |
| D1351 |
Sealant - per tooth |
146 |
37 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
59 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$0.00 |
| D0602 |
|
72 |
46 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
96 |
80 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
287 |
269 |
$0.00 |
| D1120 |
Prophylaxis - child |
693 |
633 |
$0.00 |
| D1110 |
Prophylaxis - adult |
140 |
119 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
32 |
$0.00 |
| D1354 |
|
388 |
66 |
$0.00 |