| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
2,337 |
2,016 |
$172K |
| D9999 |
Unspecified adjunctive procedure, by report |
453 |
360 |
$33K |
| D1110 |
Prophylaxis - adult |
846 |
846 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,080 |
1,079 |
$495.89 |
| D1120 |
Prophylaxis - child |
350 |
349 |
$375.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
104 |
$350.00 |
| D0274 |
Bitewings - four radiographic images |
423 |
423 |
$324.14 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
25 |
$315.00 |
| D0220 |
Intraoral - periapical first radiographic image |
995 |
961 |
$189.31 |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
115 |
$175.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
570 |
565 |
$114.00 |
| D0272 |
Bitewings - two radiographic images |
248 |
248 |
$96.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |
| D1310 |
|
18 |
18 |
$0.00 |