| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,853 |
1,449 |
$551K |
| D7140 |
Extraction, erupted tooth or exposed root |
299 |
141 |
$0.00 |
| D4346 |
|
40 |
40 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
168 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
538 |
535 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
55 |
55 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
610 |
607 |
$0.00 |
| D1330 |
|
71 |
70 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
100 |
99 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
67 |
67 |
$0.00 |
| D1110 |
Prophylaxis - adult |
229 |
229 |
$0.00 |
| D0431 |
|
120 |
119 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$0.00 |
| D9986 |
|
20 |
19 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$0.00 |