| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
593 |
557 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
277 |
$8K |
| D1120 |
Prophylaxis - child |
202 |
144 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
293 |
209 |
$6K |
| D1110 |
Prophylaxis - adult |
168 |
142 |
$4K |
| T1015 |
Clinic visit/encounter, all-inclusive |
547 |
494 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
197 |
$3K |
| D0272 |
Bitewings - two radiographic images |
84 |
57 |
$2K |
| D0330 |
Panoramic radiographic image |
74 |
72 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
79 |
$115.50 |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
49 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
68 |
68 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
65 |
63 |
$0.00 |