| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,346 |
1,244 |
$271K |
| D0274 |
Bitewings - four radiographic images |
188 |
186 |
$0.00 |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$0.00 |
| D1120 |
Prophylaxis - child |
184 |
183 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
261 |
258 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
70 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
44 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
15 |
$0.00 |
| D0603 |
|
520 |
519 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
816 |
810 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
231 |
229 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
49 |
49 |
$0.00 |
| D1351 |
Sealant - per tooth |
113 |
30 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
15 |
$0.00 |
| D0602 |
|
26 |
25 |
$0.00 |