| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
52,825 |
34,106 |
$5.44M |
| D7140 |
Extraction, erupted tooth or exposed root |
16,318 |
6,550 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,132 |
9,558 |
$11K |
| D0330 |
Panoramic radiographic image |
11,270 |
7,956 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
9,906 |
7,427 |
$6K |
| D1110 |
Prophylaxis - adult |
7,633 |
5,878 |
$5K |
| D0274 |
Bitewings - four radiographic images |
12,367 |
8,723 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,800 |
1,173 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
8,298 |
6,379 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
4,073 |
3,211 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
291 |
206 |
$1K |
| D0272 |
Bitewings - two radiographic images |
974 |
881 |
$772.26 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$348.04 |
| D1999 |
|
101 |
100 |
$139.29 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
556 |
341 |
$106.26 |
| D1206 |
Topical application of fluoride varnish |
516 |
507 |
$24.29 |
| D1120 |
Prophylaxis - child |
1,057 |
1,016 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
85 |
$0.00 |
| D2330 |
|
25 |
13 |
$0.00 |
| D2335 |
|
15 |
12 |
$0.00 |