| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
14,040 |
10,795 |
$1.39M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,230 |
1,536 |
$469.44 |
| D0210 |
Intraoral - complete series of radiographic images |
729 |
683 |
$265.30 |
| D0120 |
Periodic oral evaluation - established patient |
3,016 |
2,813 |
$212.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,506 |
1,421 |
$210.50 |
| D1110 |
Prophylaxis - adult |
823 |
759 |
$205.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
930 |
754 |
$144.45 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
726 |
602 |
$123.40 |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,085 |
$101.40 |
| D0140 |
Limited oral evaluation - problem focused |
1,548 |
1,428 |
$64.80 |
| D0220 |
Intraoral - periapical first radiographic image |
1,239 |
1,163 |
$28.00 |
| D1351 |
Sealant - per tooth |
232 |
136 |
$0.00 |
| D2330 |
|
159 |
108 |
$0.00 |
| D0601 |
|
1,444 |
1,366 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
533 |
492 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,528 |
2,389 |
$0.00 |
| D0602 |
|
1,001 |
931 |
$0.00 |
| D0603 |
|
711 |
653 |
$0.00 |
| D5899 |
|
1,175 |
844 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
133 |
$0.00 |
| D1330 |
|
114 |
97 |
$0.00 |
| D2331 |
|
239 |
183 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
25 |
$0.00 |
| D5120 |
|
25 |
25 |
$0.00 |
| D2335 |
|
14 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
820 |
763 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,504 |
2,365 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
261 |
$0.00 |
| D2332 |
|
15 |
13 |
$0.00 |
| D5110 |
|
54 |
54 |
$0.00 |
| D4910 |
|
41 |
39 |
$0.00 |