| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,479 |
3,227 |
$1.05M |
| D0140 |
Limited oral evaluation - problem focused |
662 |
648 |
$2K |
| D1120 |
Prophylaxis - child |
825 |
825 |
$537.90 |
| D1206 |
Topical application of fluoride varnish |
1,327 |
1,327 |
$315.48 |
| D0120 |
Periodic oral evaluation - established patient |
630 |
630 |
$286.29 |
| D0220 |
Intraoral - periapical first radiographic image |
402 |
399 |
$248.22 |
| D0274 |
Bitewings - four radiographic images |
231 |
231 |
$216.63 |
| D0330 |
Panoramic radiographic image |
223 |
223 |
$137.85 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
107 |
107 |
$112.68 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
245 |
239 |
$78.76 |
| D0272 |
Bitewings - two radiographic images |
343 |
343 |
$65.64 |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
96 |
$43.76 |
| D1110 |
Prophylaxis - adult |
215 |
215 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
42 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
223 |
114 |
$0.00 |
| D1330 |
|
284 |
284 |
$0.00 |
| D1351 |
Sealant - per tooth |
164 |
52 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
86 |
$0.00 |