| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,873 |
1,051 |
$329K |
| D1110 |
Prophylaxis - adult |
94 |
94 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
60 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
136 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
31 |
$338.71 |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
47 |
$0.00 |
| D1330 |
|
16 |
16 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
159 |
159 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
49 |
49 |
$0.00 |
| D1310 |
|
59 |
59 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
144 |
135 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
73 |
73 |
$0.00 |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$0.00 |