| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
36,430 |
30,146 |
$7.21M |
| D0999 |
Unspecified diagnostic procedure, by report |
31,280 |
25,786 |
$3.17M |
| D0120 |
Periodic oral evaluation - established patient |
18,583 |
18,167 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
8,541 |
8,128 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,002 |
7,798 |
$61K |
| D1120 |
Prophylaxis - child |
17,793 |
17,426 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,732 |
3,791 |
$27K |
| D0603 |
|
7,025 |
6,901 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,138 |
2,669 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,122 |
2,262 |
$20K |
| D1110 |
Prophylaxis - adult |
5,035 |
4,877 |
$17K |
| D1206 |
Topical application of fluoride varnish |
21,377 |
20,906 |
$14K |
| D0601 |
|
2,167 |
2,127 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,330 |
1,141 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
182 |
172 |
$6K |
| D0330 |
Panoramic radiographic image |
7,104 |
6,916 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
10,013 |
9,586 |
$5K |
| D2940 |
|
848 |
733 |
$4K |
| D4341 |
|
521 |
257 |
$4K |
| D0274 |
Bitewings - four radiographic images |
6,251 |
6,098 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
3,382 |
2,675 |
$3K |
| D0272 |
Bitewings - two radiographic images |
6,119 |
5,962 |
$3K |
| D1351 |
Sealant - per tooth |
4,132 |
1,592 |
$3K |
| D2331 |
|
133 |
104 |
$2K |
| D0602 |
|
1,839 |
1,804 |
$2K |
| D1354 |
|
535 |
360 |
$1K |
| D2335 |
|
17 |
15 |
$848.96 |
| D2330 |
|
88 |
71 |
$636.72 |
| D0270 |
|
561 |
549 |
$320.15 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,814 |
2,142 |
$227.21 |
| D2332 |
|
14 |
13 |
$106.12 |
| D0460 |
|
137 |
126 |
$44.56 |
| D4910 |
|
121 |
121 |
$1.01 |
| D0240 |
|
25 |
14 |
$0.15 |
| D2140 |
|
40 |
24 |
$0.00 |
| D1330 |
|
1,133 |
1,066 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
866 |
812 |
$0.00 |
| D1310 |
|
22 |
22 |
$0.00 |
| D9995 |
|
482 |
384 |
$0.00 |