| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
962 |
845 |
$316K |
| D0330 |
Panoramic radiographic image |
121 |
121 |
$0.00 |
| D1120 |
Prophylaxis - child |
284 |
284 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
34 |
34 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$0.00 |
| D1110 |
Prophylaxis - adult |
61 |
61 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
260 |
255 |
$0.00 |
| D1330 |
|
217 |
217 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
349 |
349 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
147 |
147 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
534 |
226 |
$0.00 |
| D1351 |
Sealant - per tooth |
127 |
42 |
$0.00 |
| D0603 |
|
442 |
419 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
134 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
200 |
200 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |