| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
34,437 |
26,888 |
$5.29M |
| D0999 |
Unspecified diagnostic procedure, by report |
2,598 |
2,057 |
$409K |
| D8670 |
Periodic orthodontic treatment visit |
106 |
106 |
$29K |
| D9310 |
|
2,481 |
2,411 |
$2K |
| D0330 |
Panoramic radiographic image |
2,240 |
2,240 |
$2K |
| D1351 |
Sealant - per tooth |
3,154 |
1,109 |
$2K |
| D1120 |
Prophylaxis - child |
3,085 |
3,082 |
$1K |
| D1110 |
Prophylaxis - adult |
4,548 |
4,502 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
6,409 |
6,321 |
$1K |
| D0470 |
|
358 |
349 |
$952.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,576 |
1,248 |
$900.87 |
| D0340 |
|
17 |
17 |
$880.00 |
| D1206 |
Topical application of fluoride varnish |
2,088 |
2,087 |
$807.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,036 |
4,030 |
$592.96 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,550 |
2,023 |
$541.98 |
| D0274 |
Bitewings - four radiographic images |
2,290 |
2,290 |
$464.16 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
991 |
737 |
$389.06 |
| D7140 |
Extraction, erupted tooth or exposed root |
4,104 |
2,056 |
$389.06 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
199 |
155 |
$358.15 |
| D4341 |
|
2,548 |
1,343 |
$286.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,736 |
1,735 |
$285.45 |
| D0272 |
Bitewings - two radiographic images |
1,525 |
1,525 |
$263.12 |
| D0350 |
|
17 |
17 |
$204.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,904 |
2,879 |
$186.48 |
| D0140 |
Limited oral evaluation - problem focused |
3,300 |
3,207 |
$153.39 |
| D0210 |
Intraoral - complete series of radiographic images |
1,994 |
1,985 |
$143.28 |
| D8660 |
|
14 |
14 |
$116.00 |
| D2331 |
|
843 |
654 |
$107.44 |
| D0270 |
|
1,046 |
1,039 |
$56.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
121 |
$21.12 |
| D9110 |
|
285 |
278 |
$17.91 |
| D5110 |
|
1,340 |
958 |
$0.00 |
| D2332 |
|
92 |
77 |
$0.00 |
| D0191 |
|
657 |
655 |
$0.00 |
| D4910 |
|
524 |
507 |
$0.00 |
| D9940 |
|
25 |
24 |
$0.00 |
| D0160 |
|
49 |
49 |
$0.00 |
| D9430 |
|
202 |
193 |
$0.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
230 |
164 |
$0.00 |
| D5213 |
|
293 |
224 |
$0.00 |
| D3320 |
|
44 |
38 |
$0.00 |
| D9944 |
|
32 |
30 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$0.00 |
| D4342 |
|
716 |
443 |
$0.00 |
| D5120 |
|
856 |
632 |
$0.00 |
| D5214 |
|
494 |
383 |
$0.00 |
| D2330 |
|
356 |
258 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
231 |
207 |
$0.00 |
| D0240 |
|
65 |
58 |
$0.00 |
| D9995 |
|
91 |
87 |
$0.00 |
| D9222 |
|
12 |
12 |
$0.00 |
| D2335 |
|
55 |
42 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
94 |
85 |
$0.00 |
| D3310 |
|
158 |
125 |
$0.00 |