| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
10,444 |
8,739 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
2,902 |
2,838 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,273 |
1,243 |
$27K |
| D1120 |
Prophylaxis - child |
2,787 |
2,724 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
682 |
657 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
944 |
782 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
990 |
863 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
692 |
615 |
$9K |
| D1110 |
Prophylaxis - adult |
303 |
291 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
595 |
506 |
$7K |
| D5899 |
|
67 |
41 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,099 |
$5K |
| D1206 |
Topical application of fluoride varnish |
2,763 |
2,701 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
170 |
$4K |
| D0272 |
Bitewings - two radiographic images |
643 |
629 |
$3K |
| D0601 |
|
1,444 |
1,413 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
817 |
$2K |
| D2331 |
|
33 |
29 |
$2K |
| D0330 |
Panoramic radiographic image |
909 |
892 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
447 |
442 |
$1K |
| D0602 |
|
1,225 |
1,187 |
$772.80 |
| D0603 |
|
539 |
523 |
$110.40 |
| D9310 |
|
16 |
16 |
$0.00 |
| D1351 |
Sealant - per tooth |
219 |
186 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
312 |
128 |
$0.00 |