| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
6,788 |
5,286 |
$2.67M |
| D0274 |
Bitewings - four radiographic images |
1,204 |
1,188 |
$0.00 |
| D1110 |
Prophylaxis - adult |
277 |
275 |
$0.00 |
| D0270 |
|
26 |
26 |
$0.00 |
| D0330 |
Panoramic radiographic image |
329 |
329 |
$0.00 |
| D4341 |
|
187 |
116 |
$0.00 |
| D3221 |
|
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,266 |
691 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
676 |
665 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
613 |
612 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
66 |
66 |
$0.00 |
| D1330 |
|
152 |
128 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
142 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
219 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
140 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
496 |
353 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
24 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
23 |
23 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,583 |
1,543 |
$-45.30 |
| D4910 |
|
637 |
633 |
$-240.17 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,190 |
1,709 |
$-934.54 |