| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,205 |
1,076 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
258 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
140 |
137 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
128 |
127 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
29 |
$0.00 |