| Code | Description | Claims | Beneficiaries | Total Paid |
| D0999 |
Unspecified diagnostic procedure, by report |
5,871 |
4,225 |
$568K |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,060 |
1,856 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
1,467 |
982 |
$9K |
| D1120 |
Prophylaxis - child |
1,221 |
778 |
$9K |
| D1351 |
Sealant - per tooth |
235 |
37 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,213 |
771 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
838 |
437 |
$312.96 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
213 |
190 |
$288.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
735 |
597 |
$168.40 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
288 |
173 |
$120.60 |
| D0140 |
Limited oral evaluation - problem focused |
299 |
282 |
$64.80 |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
179 |
$60.20 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$51.52 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
468 |
404 |
$46.56 |
| D0330 |
Panoramic radiographic image |
328 |
303 |
$45.20 |
| D1110 |
Prophylaxis - adult |
142 |
85 |
$41.00 |
| D0274 |
Bitewings - four radiographic images |
154 |
146 |
$33.80 |
| 96127 |
|
601 |
508 |
$14.60 |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
168 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
588 |
239 |
$0.00 |
| 99408 |
|
218 |
117 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
28 |
$0.00 |
| 80305 |
|
34 |
26 |
$0.00 |
| D0603 |
|
251 |
230 |
$0.00 |
| D1330 |
|
448 |
148 |
$0.00 |
| D0601 |
|
693 |
540 |
$0.00 |
| D0602 |
|
356 |
296 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
93 |
52 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$0.00 |