| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
857 |
723 |
$179K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,361 |
1,146 |
$110K |
| T1015 |
Clinic visit/encounter, all-inclusive |
60 |
40 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
67 |
$750.36 |
| D1120 |
Prophylaxis - child |
152 |
151 |
$623.34 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
274 |
$535.74 |
| D1206 |
Topical application of fluoride varnish |
283 |
282 |
$517.68 |
| D0330 |
Panoramic radiographic image |
242 |
242 |
$517.44 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
76 |
$493.49 |
| D0120 |
Periodic oral evaluation - established patient |
220 |
219 |
$448.89 |
| D1110 |
Prophylaxis - adult |
170 |
170 |
$447.71 |
| D0274 |
Bitewings - four radiographic images |
197 |
195 |
$286.32 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$111.18 |
| D0140 |
Limited oral evaluation - problem focused |
107 |
105 |
$62.61 |
| D0220 |
Intraoral - periapical first radiographic image |
104 |
103 |
$25.77 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$1.30 |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
29 |
$0.26 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.06 |