| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,166 |
6,403 |
$901K |
| T1015 |
Clinic visit/encounter, all-inclusive |
14 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
1,545 |
1,496 |
$738.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,559 |
1,482 |
$700.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,534 |
1,427 |
$652.55 |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
460 |
$571.90 |
| D0140 |
Limited oral evaluation - problem focused |
1,002 |
855 |
$405.00 |
| D1206 |
Topical application of fluoride varnish |
1,478 |
1,434 |
$390.00 |
| D1110 |
Prophylaxis - adult |
340 |
285 |
$164.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
279 |
162 |
$156.48 |
| D0274 |
Bitewings - four radiographic images |
536 |
509 |
$135.20 |
| D0220 |
Intraoral - periapical first radiographic image |
2,215 |
2,073 |
$5.60 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
246 |
180 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,157 |
1,020 |
$0.00 |
| D1330 |
|
659 |
426 |
$0.00 |
| D9995 |
|
82 |
54 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$0.00 |
| D1351 |
Sealant - per tooth |
25 |
12 |
$0.00 |
| D0270 |
|
25 |
24 |
$0.00 |
| D4910 |
|
27 |
14 |
$0.00 |
| D4341 |
|
77 |
44 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
29 |
$0.00 |