| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
14,867 |
12,413 |
$2.38M |
| D0999 |
Unspecified diagnostic procedure, by report |
947 |
769 |
$151K |
| D1110 |
Prophylaxis - adult |
2,133 |
2,133 |
$2K |
| D5110 |
|
130 |
82 |
$1K |
| D5120 |
|
92 |
59 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
607 |
463 |
$1K |
| D5213 |
|
215 |
135 |
$1K |
| D5214 |
|
137 |
100 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,839 |
1,329 |
$960.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,484 |
1,188 |
$610.00 |
| D2331 |
|
237 |
191 |
$609.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,180 |
4,179 |
$551.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,525 |
1,525 |
$435.00 |
| D2330 |
|
262 |
210 |
$406.00 |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
366 |
$406.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,467 |
1,120 |
$330.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,105 |
2,065 |
$315.00 |
| D0274 |
Bitewings - four radiographic images |
1,215 |
1,215 |
$290.00 |
| D2332 |
|
140 |
119 |
$216.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
231 |
216 |
$212.00 |
| D2335 |
|
153 |
124 |
$145.00 |
| D0330 |
Panoramic radiographic image |
1,273 |
1,273 |
$142.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,572 |
1,565 |
$140.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
280 |
279 |
$126.00 |
| D4341 |
|
410 |
221 |
$116.00 |
| D9110 |
|
448 |
435 |
$116.00 |
| D0272 |
Bitewings - two radiographic images |
2,408 |
2,407 |
$17.00 |
| D0270 |
|
460 |
456 |
$0.00 |
| D0190 |
|
81 |
81 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
461 |
454 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
497 |
353 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
170 |
170 |
$0.00 |
| D3320 |
|
108 |
91 |
$0.00 |
| D4910 |
|
90 |
90 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,071 |
3,069 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
17 |
14 |
$0.00 |
| D1354 |
|
33 |
16 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
192 |
162 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,629 |
3,627 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
615 |
615 |
$0.00 |
| D0240 |
|
253 |
244 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,444 |
911 |
$0.00 |
| D4342 |
|
55 |
38 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
43 |
$0.00 |
| D7230 |
|
17 |
13 |
$0.00 |
| D3310 |
|
49 |
37 |
$0.00 |
| D2752 |
|
104 |
67 |
$0.00 |