| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
16,468 |
13,414 |
$3.30M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
144 |
127 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,467 |
1,070 |
$128.85 |
| D0140 |
Limited oral evaluation - problem focused |
2,023 |
1,997 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,857 |
1,857 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,711 |
1,292 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,474 |
2,470 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,390 |
1,390 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
853 |
853 |
$0.00 |
| D0603 |
|
17 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
3,509 |
3,500 |
$0.00 |
| D1354 |
|
1,635 |
345 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,536 |
1,536 |
$0.00 |
| D0330 |
Panoramic radiographic image |
951 |
951 |
$0.00 |
| D1120 |
Prophylaxis - child |
136 |
136 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
761 |
500 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
44 |
$0.00 |
| D9986 |
|
120 |
118 |
$0.00 |
| D2940 |
|
24 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,479 |
1,456 |
$-216.60 |