| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,510 |
1,410 |
$170K |
| D0272 |
Bitewings - two radiographic images |
43 |
43 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
74 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
318 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
197 |
196 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
74 |
74 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
85 |
85 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
51 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
64 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
379 |
$0.00 |
| D1120 |
Prophylaxis - child |
249 |
248 |
$0.00 |
| D9110 |
|
25 |
24 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$0.00 |