| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
9,130 |
7,365 |
$1.43M |
| D0999 |
Unspecified diagnostic procedure, by report |
715 |
586 |
$100K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
307 |
306 |
$15K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
40 |
40 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27 |
27 |
$1K |
| D1110 |
Prophylaxis - adult |
1,411 |
1,403 |
$140.10 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,139 |
$84.10 |
| D9110 |
|
35 |
33 |
$26.86 |
| D0140 |
Limited oral evaluation - problem focused |
590 |
590 |
$12.35 |
| D1206 |
Topical application of fluoride varnish |
181 |
181 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
466 |
466 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
712 |
575 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
403 |
401 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,224 |
593 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,163 |
2,143 |
$0.00 |
| D5120 |
|
297 |
224 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
492 |
$0.00 |
| D5214 |
|
112 |
93 |
$0.00 |
| D9310 |
|
546 |
542 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
53 |
$0.00 |
| D2330 |
|
61 |
50 |
$0.00 |
| D1351 |
Sealant - per tooth |
704 |
228 |
$0.00 |
| D0470 |
|
90 |
89 |
$0.00 |
| D4342 |
|
355 |
215 |
$0.00 |
| D2331 |
|
228 |
176 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
62 |
$0.00 |
| D9222 |
|
13 |
13 |
$0.00 |
| D2335 |
|
22 |
12 |
$0.00 |
| D3310 |
|
42 |
36 |
$0.00 |
| D9995 |
|
48 |
48 |
$0.00 |
| D1120 |
Prophylaxis - child |
623 |
623 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
918 |
917 |
$0.00 |
| D0270 |
|
225 |
225 |
$0.00 |
| D0330 |
Panoramic radiographic image |
729 |
729 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
507 |
394 |
$0.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
46 |
29 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
837 |
834 |
$0.00 |
| D4910 |
|
102 |
100 |
$0.00 |
| D0251 |
|
125 |
125 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
120 |
$0.00 |
| D3320 |
|
67 |
64 |
$0.00 |
| D5110 |
|
364 |
286 |
$0.00 |
| D4341 |
|
959 |
480 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
89 |
60 |
$0.00 |
| D5213 |
|
35 |
27 |
$0.00 |