| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
78,926 |
71,819 |
$18.47M |
| D9248 |
|
12 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
42,508 |
41,586 |
$348.88 |
| D1351 |
Sealant - per tooth |
9,991 |
2,555 |
$299.07 |
| D1120 |
Prophylaxis - child |
19,850 |
19,399 |
$254.22 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,616 |
1,227 |
$93.00 |
| D0120 |
Periodic oral evaluation - established patient |
12,819 |
12,464 |
$87.24 |
| D0140 |
Limited oral evaluation - problem focused |
5,980 |
5,720 |
$86.40 |
| D1110 |
Prophylaxis - adult |
7,316 |
7,095 |
$58.15 |
| D0330 |
Panoramic radiographic image |
4,036 |
3,942 |
$42.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,069 |
2,901 |
$18.00 |
| D0220 |
Intraoral - periapical first radiographic image |
5,269 |
5,018 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
7,132 |
6,901 |
$0.00 |
| D2940 |
|
184 |
84 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
456 |
343 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
266 |
265 |
$0.00 |
| D1354 |
|
122 |
22 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,508 |
1,951 |
$0.00 |
| D3120 |
|
138 |
122 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
2,015 |
1,310 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
3,243 |
3,155 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,382 |
$0.00 |
| D1330 |
|
4,366 |
4,141 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
257 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
29 |
$0.00 |
| D0240 |
|
56 |
53 |
$0.00 |