| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
26,907 |
23,895 |
$6.64M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
828 |
701 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
60 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,925 |
2,994 |
$7K |
| D4341 |
|
796 |
392 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,401 |
1,191 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
3,199 |
3,171 |
$31.55 |
| D0274 |
Bitewings - four radiographic images |
3,162 |
3,160 |
$0.00 |
| D1110 |
Prophylaxis - adult |
5,402 |
5,397 |
$0.00 |
| D0270 |
|
942 |
939 |
$0.00 |
| D0330 |
Panoramic radiographic image |
124 |
124 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,730 |
1,730 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,693 |
3,690 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,255 |
3,251 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,846 |
1,843 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
778 |
778 |
$0.00 |
| D1351 |
Sealant - per tooth |
710 |
205 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
161 |
161 |
$0.00 |
| D2331 |
|
19 |
13 |
$0.00 |
| D4342 |
|
25 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,204 |
946 |
$-97.45 |
| D0220 |
Intraoral - periapical first radiographic image |
7,393 |
7,336 |
$-246.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,254 |
4,395 |
$-291.80 |
| D4910 |
|
1,012 |
979 |
$-430.48 |