| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
275 |
242 |
$68K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
96 |
$0.00 |
| D1110 |
Prophylaxis - adult |
33 |
33 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
57 |
57 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
82 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
14 |
$0.00 |