| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
17,383 |
9,142 |
$1.31M |
| D7140 |
Extraction, erupted tooth or exposed root |
4,442 |
1,359 |
$20K |
| D0330 |
Panoramic radiographic image |
2,515 |
1,395 |
$7K |
| D1110 |
Prophylaxis - adult |
4,392 |
2,473 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
2,208 |
1,117 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,594 |
2,208 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
4,219 |
2,509 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
1,338 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,485 |
788 |
$956.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
391 |
233 |
$491.59 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
117 |
$433.42 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
33 |
$300.63 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
52 |
$106.67 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$101.57 |
| D0272 |
Bitewings - two radiographic images |
1,276 |
764 |
$69.98 |
| D1120 |
Prophylaxis - child |
1,210 |
814 |
$0.00 |
| D1310 |
|
236 |
147 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,149 |
706 |
$0.00 |
| D9215 |
|
231 |
117 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
230 |
103 |
$0.00 |