| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
5,590 |
3,896 |
$587K |
| D0999 |
Unspecified diagnostic procedure, by report |
3,469 |
2,494 |
$468K |
| D0220 |
Intraoral - periapical first radiographic image |
2,270 |
2,260 |
$0.00 |
| D0330 |
Panoramic radiographic image |
374 |
374 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,014 |
2,074 |
$0.00 |
| D1120 |
Prophylaxis - child |
648 |
648 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,407 |
2,406 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,479 |
1,479 |
$0.00 |
| D4341 |
|
122 |
45 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
884 |
884 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,592 |
2,592 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
513 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
307 |
307 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
542 |
542 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
177 |
169 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
347 |
347 |
$0.00 |
| D1330 |
|
708 |
707 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
165 |
165 |
$0.00 |