| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
553 |
464 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,885 |
663 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,934 |
1,823 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
585 |
425 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,006 |
984 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,284 |
1,251 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,370 |
1,328 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
309 |
$17K |
| D1120 |
Prophylaxis - child |
832 |
806 |
$17K |
| D1110 |
Prophylaxis - adult |
369 |
358 |
$13K |
| D9420 |
|
265 |
182 |
$9K |
| D1999 |
|
679 |
552 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
438 |
394 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
1,047 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
256 |
250 |
$7K |
| D2331 |
|
64 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
292 |
281 |
$3K |
| D9920 |
|
122 |
114 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
25 |
$2K |
| D9992 |
|
163 |
161 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
132 |
125 |
$2K |
| D0330 |
Panoramic radiographic image |
76 |
74 |
$1K |
| D2330 |
|
34 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
544 |
217 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$299.46 |
| D1354 |
|
46 |
12 |
$135.00 |
| D0270 |
|
15 |
14 |
$77.28 |