| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
10,246 |
8,382 |
$1.06M |
| T1015 |
Clinic visit/encounter, all-inclusive |
120 |
92 |
$11K |
| D1120 |
Prophylaxis - child |
2,320 |
2,280 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
788 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
803 |
670 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
801 |
789 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
2,366 |
2,324 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
585 |
487 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
432 |
$3K |
| D1110 |
Prophylaxis - adult |
313 |
303 |
$1K |
| D1206 |
Topical application of fluoride varnish |
2,385 |
2,354 |
$924.84 |
| D0220 |
Intraoral - periapical first radiographic image |
780 |
770 |
$497.41 |
| D0274 |
Bitewings - four radiographic images |
869 |
858 |
$227.12 |
| D0330 |
Panoramic radiographic image |
450 |
443 |
$112.00 |
| D0272 |
Bitewings - two radiographic images |
307 |
307 |
$66.54 |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$0.00 |
| 1036F |
|
12 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
46 |
40 |
$0.00 |
| 3008F |
|
14 |
14 |
$0.00 |
| 2010F |
|
15 |
15 |
$0.00 |
| 2000F |
|
14 |
14 |
$0.00 |
| 2001F |
|
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
15 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
27 |
$0.00 |