| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
716 |
671 |
$175K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
93 |
58 |
$6K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
43 |
25 |
$2K |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
71 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$0.00 |