| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,336 |
977 |
$647K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
37 |
$17K |
| 90686 |
|
26 |
26 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
118 |
$10K |
| D1206 |
Topical application of fluoride varnish |
164 |
128 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
303 |
227 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
25 |
25 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
21 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
22 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$702.00 |
| 90480 |
|
14 |
14 |
$0.00 |