| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
27,605 |
22,820 |
$6.28M |
| D0140 |
Limited oral evaluation - problem focused |
3,281 |
3,011 |
$88K |
| D1110 |
Prophylaxis - adult |
2,336 |
2,137 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,592 |
1,512 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
822 |
456 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,349 |
4,030 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
2,056 |
1,931 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
149 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
320 |
253 |
$22K |
| D1120 |
Prophylaxis - child |
1,005 |
935 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,498 |
1,406 |
$13K |
| D0274 |
Bitewings - four radiographic images |
333 |
314 |
$5K |
| D0330 |
Panoramic radiographic image |
140 |
137 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
16 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
146 |
122 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
24 |
$816.00 |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
127 |
$604.00 |
| D1351 |
Sealant - per tooth |
109 |
29 |
$488.00 |
| D0270 |
|
46 |
39 |
$420.00 |