| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
17,290 |
13,776 |
$1.80M |
| D1110 |
Prophylaxis - adult |
1,193 |
1,114 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,718 |
1,629 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,621 |
1,549 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,383 |
3,170 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,085 |
901 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
363 |
330 |
$0.00 |
| D5110 |
|
29 |
29 |
$0.00 |
| D0330 |
Panoramic radiographic image |
308 |
291 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
15 |
$0.00 |
| D2140 |
|
34 |
32 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
14 |
$0.00 |
| D2332 |
|
15 |
12 |
$0.00 |
| D2940 |
|
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,720 |
3,488 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,083 |
2,945 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
454 |
442 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,187 |
1,145 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
483 |
469 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
41 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
953 |
792 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,696 |
1,588 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
3,828 |
2,191 |
$0.00 |
| D5120 |
|
16 |
16 |
$0.00 |
| D1351 |
Sealant - per tooth |
157 |
72 |
$0.00 |
| D0602 |
|
57 |
57 |
$0.00 |
| D2330 |
|
88 |
72 |
$0.00 |
| D2331 |
|
90 |
75 |
$0.00 |
| D5899 |
|
179 |
148 |
$0.00 |
| D0603 |
|
99 |
99 |
$0.00 |