| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
27,959 |
20,606 |
$6.03M |
| D1206 |
Topical application of fluoride varnish |
7,898 |
5,998 |
$137K |
| D1120 |
Prophylaxis - child |
3,438 |
2,614 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
4,247 |
3,128 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
7,163 |
5,357 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,235 |
1,627 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,669 |
4,202 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,620 |
1,285 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,156 |
1,622 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,286 |
932 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
38 |
$15K |
| D0274 |
Bitewings - four radiographic images |
557 |
421 |
$11K |
| D1110 |
Prophylaxis - adult |
254 |
198 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
116 |
83 |
$7K |
| D0330 |
Panoramic radiographic image |
121 |
90 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
152 |
$3K |
| D1351 |
Sealant - per tooth |
305 |
87 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
106 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
249 |
$2K |
| D0190 |
|
3,700 |
3,251 |
$1K |
| D1354 |
|
14 |
14 |
$125.18 |
| D0270 |
|
31 |
31 |
$16.09 |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
30 |
$0.00 |