| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
4,133 |
3,185 |
$487K |
| D1110 |
Prophylaxis - adult |
2,438 |
1,964 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,453 |
1,085 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
642 |
427 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,775 |
635 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
406 |
212 |
$542.48 |
| D0274 |
Bitewings - four radiographic images |
1,005 |
832 |
$423.60 |
| D0140 |
Limited oral evaluation - problem focused |
367 |
302 |
$422.10 |
| D0330 |
Panoramic radiographic image |
754 |
614 |
$347.82 |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
444 |
$130.89 |
| D0120 |
Periodic oral evaluation - established patient |
370 |
335 |
$80.49 |
| D0270 |
|
19 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
16 |
$0.00 |