| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,810 |
7,363 |
$3.44M |
| D0140 |
Limited oral evaluation - problem focused |
1,704 |
1,512 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
371 |
172 |
$26K |
| D1110 |
Prophylaxis - adult |
675 |
579 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
81 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
540 |
489 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,524 |
1,347 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
376 |
334 |
$8K |
| D0274 |
Bitewings - four radiographic images |
192 |
172 |
$4K |
| D0330 |
Panoramic radiographic image |
229 |
207 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
118 |
$3K |
| D1206 |
Topical application of fluoride varnish |
274 |
269 |
$2K |
| D1120 |
Prophylaxis - child |
70 |
66 |
$483.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
53 |
$78.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |