| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
5,550 |
4,148 |
$507K |
| D0120 |
Periodic oral evaluation - established patient |
6,087 |
5,525 |
$260K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,250 |
1,057 |
$34K |
| D1120 |
Prophylaxis - child |
4,327 |
3,807 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,001 |
868 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,689 |
1,511 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
780 |
676 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
551 |
486 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
949 |
845 |
$8K |
| D1206 |
Topical application of fluoride varnish |
4,542 |
3,906 |
$7K |
| D1351 |
Sealant - per tooth |
220 |
192 |
$5K |
| D0274 |
Bitewings - four radiographic images |
904 |
829 |
$5K |
| D0330 |
Panoramic radiographic image |
589 |
547 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,262 |
1,098 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
99 |
$233.50 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
25 |
$106.85 |
| D0603 |
|
422 |
396 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
25 |
$0.00 |
| D0601 |
|
150 |
150 |
$0.00 |
| D0602 |
|
75 |
75 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
136 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$0.00 |
| D4341 |
|
17 |
12 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
97 |
62 |
$0.00 |