| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
11,964 |
9,197 |
$1.28M |
| D4341 |
|
667 |
311 |
$976.00 |
| D0210 |
Intraoral - complete series of radiographic images |
2,236 |
2,054 |
$713.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,223 |
1,944 |
$710.74 |
| D1110 |
Prophylaxis - adult |
319 |
269 |
$357.52 |
| D0140 |
Limited oral evaluation - problem focused |
1,454 |
1,244 |
$338.32 |
| D9995 |
|
70 |
47 |
$275.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
389 |
$227.28 |
| D0120 |
Periodic oral evaluation - established patient |
396 |
353 |
$56.00 |
| D0220 |
Intraoral - periapical first radiographic image |
914 |
830 |
$39.66 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
87 |
$36.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
432 |
394 |
$8.96 |
| D0274 |
Bitewings - four radiographic images |
184 |
161 |
$0.00 |
| D4910 |
|
59 |
58 |
$0.00 |
| D1120 |
Prophylaxis - child |
108 |
98 |
$0.00 |
| D0180 |
|
310 |
238 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,190 |
1,016 |
$0.00 |
| D0603 |
|
218 |
161 |
$0.00 |
| D4342 |
|
249 |
130 |
$0.00 |
| D1310 |
|
579 |
465 |
$0.00 |
| D0602 |
|
21 |
17 |
$0.00 |
| D1330 |
|
340 |
203 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |