| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
23,507 |
21,832 |
$5.91M |
| D1120 |
Prophylaxis - child |
8,580 |
8,335 |
$158K |
| D1206 |
Topical application of fluoride varnish |
12,376 |
12,061 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
7,032 |
6,832 |
$84K |
| D1351 |
Sealant - per tooth |
2,592 |
585 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,965 |
1,916 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
287 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,920 |
1,842 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
289 |
230 |
$18K |
| D0330 |
Panoramic radiographic image |
1,322 |
1,295 |
$17K |
| D0274 |
Bitewings - four radiographic images |
2,257 |
2,200 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
41 |
$10K |
| D1110 |
Prophylaxis - adult |
674 |
654 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
257 |
251 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,124 |
2,067 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
233 |
233 |
$1K |
| D1330 |
|
1,113 |
1,108 |
$366.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$276.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,314 |
1,290 |
$210.00 |
| 90657 |
|
32 |
32 |
$0.00 |