| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
967 |
883 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
644 |
643 |
$7K |
| D0330 |
Panoramic radiographic image |
258 |
258 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
94 |
$2K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$765.00 |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$544.00 |
| D0120 |
Periodic oral evaluation - established patient |
70 |
70 |
$494.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$370.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
56 |
$287.00 |