| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
936 |
653 |
$183K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
130 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
243 |
243 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
16 |
$2K |
| D1120 |
Prophylaxis - child |
173 |
173 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
41 |
$2K |
| D0274 |
Bitewings - four radiographic images |
45 |
45 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
104 |
$1K |
| D1110 |
Prophylaxis - adult |
33 |
33 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
33 |
33 |
$767.67 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
70 |
$752.19 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
17 |
$558.31 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$251.27 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
28 |
$0.00 |
| D1330 |
|
223 |
205 |
$0.00 |