| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
107,107 |
91,339 |
$17.06M |
| D0999 |
Unspecified diagnostic procedure, by report |
14,758 |
12,718 |
$2.34M |
| D5110 |
|
1,194 |
825 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
15,541 |
11,427 |
$19K |
| D5120 |
|
468 |
317 |
$15K |
| D1110 |
Prophylaxis - adult |
14,699 |
14,694 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
30,847 |
30,838 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,840 |
3,014 |
$9K |
| D5214 |
|
892 |
632 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,694 |
7,938 |
$7K |
| D5213 |
|
859 |
599 |
$7K |
| D4341 |
|
3,460 |
1,918 |
$6K |
| D0330 |
Panoramic radiographic image |
12,770 |
12,756 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,169 |
7,282 |
$5K |
| D2330 |
|
2,254 |
1,744 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
18,954 |
18,566 |
$5K |
| D2331 |
|
1,949 |
1,607 |
$5K |
| D0274 |
Bitewings - four radiographic images |
11,539 |
11,534 |
$4K |
| D2335 |
|
1,076 |
865 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,458 |
8,453 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,843 |
1,711 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
16,318 |
16,278 |
$4K |
| D2332 |
|
1,021 |
851 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
2,255 |
2,255 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,560 |
3,542 |
$2K |
| D4910 |
|
890 |
890 |
$2K |
| D9110 |
|
5,258 |
5,173 |
$2K |
| D4342 |
|
1,174 |
691 |
$2K |
| D2394 |
|
87 |
85 |
$568.00 |
| D0272 |
Bitewings - two radiographic images |
15,340 |
15,330 |
$449.00 |
| D7230 |
|
216 |
153 |
$360.00 |
| D0270 |
|
4,008 |
3,957 |
$312.00 |
| D9944 |
|
70 |
65 |
$286.38 |
| D3310 |
|
625 |
476 |
$250.00 |
| D7250 |
|
103 |
82 |
$172.26 |
| D9940 |
|
15 |
12 |
$145.00 |
| D0273 |
|
70 |
70 |
$87.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
791 |
721 |
$87.00 |
| D9920 |
|
99 |
92 |
$57.00 |
| D2752 |
|
882 |
646 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,720 |
3,720 |
$0.00 |
| D0240 |
|
2,191 |
2,116 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
22,605 |
22,601 |
$0.00 |
| D9248 |
|
205 |
193 |
$0.00 |
| D1351 |
Sealant - per tooth |
11,388 |
4,277 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
277 |
232 |
$0.00 |
| D9997 |
|
15 |
13 |
$0.00 |
| D1515 |
|
18 |
14 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
18,987 |
18,982 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,043 |
1,584 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,156 |
1,156 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,958 |
2,887 |
$0.00 |
| D3320 |
|
737 |
593 |
$0.00 |
| D0190 |
|
176 |
176 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
458 |
313 |
$0.00 |
| D2140 |
|
71 |
62 |
$0.00 |
| D1354 |
|
285 |
128 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
70 |
$0.00 |
| D2954 |
|
121 |
112 |
$0.00 |
| D1510 |
|
22 |
14 |
$0.00 |