| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,693 |
7,005 |
$1.98M |
| D0140 |
Limited oral evaluation - problem focused |
305 |
301 |
$268.59 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
633 |
$19.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,425 |
1,711 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
981 |
980 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
196 |
196 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
807 |
806 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
722 |
722 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,780 |
2,731 |
$0.00 |
| D1110 |
Prophylaxis - adult |
992 |
992 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,382 |
1,380 |
$0.00 |
| D1120 |
Prophylaxis - child |
69 |
68 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
38 |
$0.00 |