| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,296 |
6,638 |
$1.67M |
| D9999 |
Unspecified adjunctive procedure, by report |
7,785 |
7,031 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,521 |
769 |
$734.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
118 |
115 |
$566.34 |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,818 |
$504.71 |
| D1110 |
Prophylaxis - adult |
1,254 |
1,250 |
$486.89 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
396 |
394 |
$400.35 |
| D0274 |
Bitewings - four radiographic images |
593 |
591 |
$398.46 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
30 |
$238.75 |
| D0601 |
|
670 |
670 |
$220.00 |
| D1206 |
Topical application of fluoride varnish |
2,570 |
2,567 |
$198.27 |
| D0330 |
Panoramic radiographic image |
202 |
202 |
$142.28 |
| D0140 |
Limited oral evaluation - problem focused |
1,062 |
1,041 |
$72.21 |
| D0602 |
|
162 |
162 |
$45.00 |
| D0220 |
Intraoral - periapical first radiographic image |
997 |
972 |
$44.17 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
37 |
$39.14 |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
63 |
$2.40 |
| D1120 |
Prophylaxis - child |
863 |
862 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$0.00 |
| D1310 |
|
200 |
200 |
$0.00 |
| D1330 |
|
643 |
639 |
$0.00 |
| D0603 |
|
430 |
430 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D9995 |
|
14 |
14 |
$0.00 |