| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
9,517 |
8,412 |
$2.22M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,810 |
1,783 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,228 |
1,214 |
$6K |
| D1206 |
Topical application of fluoride varnish |
1,110 |
1,093 |
$5K |
| D1120 |
Prophylaxis - child |
367 |
359 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,782 |
2,737 |
$4K |
| D0330 |
Panoramic radiographic image |
1,026 |
1,010 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,236 |
2,206 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
95 |
95 |
$2K |
| D0272 |
Bitewings - two radiographic images |
98 |
98 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,247 |
1,226 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$741.00 |
| D1330 |
|
368 |
367 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
114 |
113 |
$0.00 |
| D1110 |
Prophylaxis - adult |
495 |
495 |
$0.00 |