| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
25,900 |
22,775 |
$3.61M |
| T1015 |
Clinic visit/encounter, all-inclusive |
26,383 |
21,829 |
$367K |
| D9999 |
Unspecified adjunctive procedure, by report |
770 |
666 |
$135K |
| D1120 |
Prophylaxis - child |
11,227 |
10,285 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
13,416 |
12,351 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,424 |
15,118 |
$95K |
| D1110 |
Prophylaxis - adult |
6,300 |
5,866 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,492 |
2,578 |
$76K |
| D0330 |
Panoramic radiographic image |
4,446 |
4,083 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,008 |
2,141 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,950 |
2,059 |
$48K |
| D0274 |
Bitewings - four radiographic images |
5,938 |
5,430 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
5,871 |
5,237 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,294 |
3,713 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,397 |
3,116 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
7,866 |
6,862 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
666 |
573 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,767 |
3,224 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
223 |
206 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,888 |
1,727 |
$11K |
| D1351 |
Sealant - per tooth |
1,783 |
500 |
$11K |
| D2335 |
|
308 |
224 |
$10K |
| D2394 |
|
161 |
104 |
$6K |
| D9995 |
|
301 |
207 |
$6K |
| D2332 |
|
105 |
88 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
447 |
415 |
$3K |
| D2330 |
|
18 |
13 |
$748.00 |
| D2331 |
|
59 |
48 |
$679.80 |
| D0270 |
|
81 |
71 |
$99.00 |
| D3120 |
|
247 |
179 |
$0.00 |
| D1310 |
|
182 |
165 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
13 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
382 |
190 |
$0.00 |
| D0460 |
|
89 |
83 |
$0.00 |