| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
6,817 |
5,817 |
$1.97M |
| T1015 |
Clinic visit/encounter, all-inclusive |
240 |
157 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
1,135 |
1,126 |
$0.00 |
| D0330 |
Panoramic radiographic image |
724 |
723 |
$0.00 |
| D0270 |
|
26 |
26 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,180 |
1,170 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
19 |
12 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
516 |
291 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
625 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
17 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
293 |
293 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
579 |
578 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
144 |
101 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
29 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,091 |
1,090 |
$-337.59 |
| D1208 |
Topical application of fluoride, excluding varnish |
774 |
773 |
$-337.59 |