| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
17,659 |
13,960 |
$3.88M |
| T1015 |
Clinic visit/encounter, all-inclusive |
11,814 |
9,985 |
$2.82M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,846 |
1,389 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,837 |
4,457 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
4,998 |
4,685 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
3,212 |
2,999 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,864 |
1,374 |
$48K |
| D1110 |
Prophylaxis - adult |
3,794 |
3,602 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
4,420 |
4,161 |
$37K |
| D1206 |
Topical application of fluoride varnish |
5,078 |
4,624 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
8,181 |
7,584 |
$26K |
| D0330 |
Panoramic radiographic image |
1,759 |
1,692 |
$18K |
| D1999 |
|
773 |
668 |
$16K |
| D0274 |
Bitewings - four radiographic images |
3,193 |
2,987 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
605 |
455 |
$11K |
| D1351 |
Sealant - per tooth |
2,964 |
601 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
54 |
$9K |
| D1120 |
Prophylaxis - child |
1,176 |
1,107 |
$8K |
| D9992 |
|
508 |
482 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,686 |
4,649 |
$6K |
| D0270 |
|
1,728 |
1,666 |
$6K |
| D9995 |
|
271 |
267 |
$300.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$51.45 |
| D0603 |
|
107 |
68 |
$0.00 |
| D4999 |
|
28 |
14 |
$0.00 |
| D2940 |
|
14 |
12 |
$0.00 |
| D4341 |
|
24 |
12 |
$0.00 |