| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
39,425 |
26,966 |
$3.92M |
| D7140 |
Extraction, erupted tooth or exposed root |
12,941 |
6,528 |
$79K |
| D0330 |
Panoramic radiographic image |
8,782 |
6,618 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,099 |
6,958 |
$25K |
| D1110 |
Prophylaxis - adult |
8,688 |
6,905 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,058 |
1,309 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
3,205 |
2,274 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
7,725 |
6,524 |
$5K |
| D0274 |
Bitewings - four radiographic images |
5,394 |
4,063 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,000 |
1,301 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,249 |
2,383 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
39 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
84 |
$361.02 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$163.14 |
| D0272 |
Bitewings - two radiographic images |
1,369 |
1,241 |
$59.69 |
| D1208 |
Topical application of fluoride, excluding varnish |
7,209 |
6,459 |
$20.54 |
| D1120 |
Prophylaxis - child |
5,400 |
4,864 |
$1.02 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
14 |
$0.00 |
| D1999 |
|
266 |
248 |
$0.00 |