| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
124,605 |
117,365 |
$23.29M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,581 |
5,129 |
$840.00 |
| D1206 |
Topical application of fluoride varnish |
76,062 |
74,718 |
$623.00 |
| D1120 |
Prophylaxis - child |
32,148 |
31,597 |
$551.81 |
| D0140 |
Limited oral evaluation - problem focused |
13,636 |
13,301 |
$302.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,015 |
7,855 |
$206.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,262 |
3,999 |
$186.00 |
| D0120 |
Periodic oral evaluation - established patient |
30,838 |
30,298 |
$145.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
4,165 |
2,716 |
$103.01 |
| D1351 |
Sealant - per tooth |
11,602 |
4,138 |
$99.69 |
| D0272 |
Bitewings - two radiographic images |
14,228 |
13,993 |
$90.00 |
| D0330 |
Panoramic radiographic image |
6,326 |
6,203 |
$84.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,860 |
1,837 |
$80.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
268 |
268 |
$23.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
433 |
404 |
$18.00 |
| D0220 |
Intraoral - periapical first radiographic image |
10,145 |
9,870 |
$18.00 |
| D9910 |
|
2,112 |
2,050 |
$10.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
128 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
2,828 |
2,773 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
711 |
682 |
$0.00 |
| D4355 |
|
263 |
255 |
$0.00 |
| D3120 |
|
105 |
94 |
$0.00 |
| D0240 |
|
14 |
14 |
$0.00 |
| D2331 |
|
17 |
12 |
$0.00 |
| D7111 |
|
17 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
8,385 |
8,217 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,445 |
1,901 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
5,936 |
5,824 |
$0.00 |
| D0270 |
|
1,478 |
1,450 |
$0.00 |
| D2940 |
|
210 |
122 |
$0.00 |