| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
2,074 |
1,809 |
$151K |
| D1110 |
Prophylaxis - adult |
724 |
724 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,173 |
1,173 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
1,041 |
$12K |
| D9999 |
Unspecified adjunctive procedure, by report |
119 |
110 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,554 |
1,538 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,264 |
1,257 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
241 |
196 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
82 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
49 |
$879.10 |
| D1120 |
Prophylaxis - child |
108 |
108 |
$503.10 |
| D9991 |
|
33 |
30 |
$117.00 |
| D0270 |
|
13 |
13 |
$80.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
16 |
$35.31 |
| D9995 |
|
21 |
18 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
61 |
$0.00 |
| D1330 |
|
14 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$0.00 |
| D1310 |
|
14 |
14 |
$0.00 |