| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
575 |
442 |
$124K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
72 |
$5K |
| D0274 |
Bitewings - four radiographic images |
82 |
82 |
$4K |
| D1110 |
Prophylaxis - adult |
47 |
47 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
131 |
128 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
41 |
$2K |
| D1206 |
Topical application of fluoride varnish |
48 |
48 |
$2K |
| D1120 |
Prophylaxis - child |
26 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
82 |
$1K |