| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,511 |
7,412 |
$2.11M |
| D1120 |
Prophylaxis - child |
3,020 |
2,727 |
$46K |
| D1206 |
Topical application of fluoride varnish |
6,041 |
5,478 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,690 |
1,502 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
453 |
363 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
269 |
$9K |
| D0272 |
Bitewings - two radiographic images |
549 |
474 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
774 |
653 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
56 |
$7K |
| D1351 |
Sealant - per tooth |
406 |
107 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
40 |
$6K |
| D0330 |
Panoramic radiographic image |
85 |
66 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
161 |
123 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
38 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
533 |
446 |
$4K |
| D0274 |
Bitewings - four radiographic images |
17 |
13 |
$544.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$0.00 |