| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
395 |
385 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
45 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
330 |
321 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$0.00 |
| D1110 |
Prophylaxis - adult |
45 |
45 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$0.00 |