| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,276 |
2,786 |
$359K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
77 |
60 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
59 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
37 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,018 |
1,002 |
$0.00 |
| D1120 |
Prophylaxis - child |
177 |
177 |
$0.00 |
| D0330 |
Panoramic radiographic image |
131 |
131 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
321 |
321 |
$0.00 |
| D1110 |
Prophylaxis - adult |
44 |
44 |
$0.00 |
| D0270 |
|
15 |
15 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
147 |
147 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
242 |
239 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,001 |
600 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
346 |
346 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
343 |
343 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
202 |
45 |
$0.00 |