| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,034 |
6,036 |
$1.68M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
75 |
$138.49 |
| D1110 |
Prophylaxis - adult |
1,054 |
983 |
$134.78 |
| D0140 |
Limited oral evaluation - problem focused |
282 |
266 |
$47.26 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
246 |
$42.50 |
| D0120 |
Periodic oral evaluation - established patient |
1,749 |
1,543 |
$28.70 |
| D1206 |
Topical application of fluoride varnish |
1,113 |
921 |
$7.92 |
| D1330 |
|
201 |
185 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
308 |
293 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
401 |
386 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
352 |
348 |
$0.00 |