| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
17,125 |
9,308 |
$2.91M |
| D1110 |
Prophylaxis - adult |
1,214 |
1,211 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,325 |
1,309 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,430 |
517 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
483 |
353 |
$3K |
| D4910 |
|
25 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,657 |
1,609 |
$958.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
822 |
821 |
$699.45 |
| D0120 |
Periodic oral evaluation - established patient |
822 |
820 |
$323.81 |
| D1206 |
Topical application of fluoride varnish |
399 |
398 |
$323.81 |
| D1120 |
Prophylaxis - child |
38 |
38 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
529 |
527 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
126 |
$0.00 |
| D4341 |
|
30 |
13 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
324 |
324 |
$0.00 |
| D1351 |
Sealant - per tooth |
48 |
13 |
$0.00 |