| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
23,815 |
20,970 |
$3.36M |
| D1110 |
Prophylaxis - adult |
2,159 |
2,159 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,456 |
2,104 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,817 |
2,805 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,610 |
1,311 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,426 |
1,249 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
1,804 |
1,804 |
$2K |
| D0330 |
Panoramic radiographic image |
731 |
731 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
3,327 |
3,274 |
$2K |
| D4341 |
|
747 |
486 |
$2K |
| D1120 |
Prophylaxis - child |
429 |
429 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
3,684 |
3,646 |
$856.87 |
| D0274 |
Bitewings - four radiographic images |
926 |
926 |
$648.00 |
| D3320 |
|
245 |
216 |
$600.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
165 |
141 |
$510.00 |
| D2740 |
Crown - porcelain/ceramic |
384 |
325 |
$500.00 |
| D1206 |
Topical application of fluoride varnish |
434 |
434 |
$466.40 |
| D7140 |
Extraction, erupted tooth or exposed root |
259 |
198 |
$400.00 |
| D2752 |
|
220 |
196 |
$400.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
64 |
$393.60 |
| D2331 |
|
43 |
39 |
$365.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,149 |
1,144 |
$275.00 |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$250.00 |
| D0270 |
|
1,012 |
1,008 |
$224.00 |
| D0272 |
Bitewings - two radiographic images |
273 |
273 |
$112.00 |
| D2330 |
|
16 |
12 |
$100.00 |
| D4910 |
|
85 |
85 |
$45.00 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
118 |
97 |
$0.00 |
| D4342 |
|
47 |
24 |
$0.00 |
| D3310 |
|
17 |
14 |
$0.00 |
| D3348 |
|
29 |
24 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
70 |
66 |
$0.00 |