| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
3,289 |
2,576 |
$336K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,644 |
1,623 |
$283K |
| D1206 |
Topical application of fluoride varnish |
616 |
595 |
$25.92 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
245 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
251 |
229 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,351 |
913 |
$0.00 |
| 1036F |
|
95 |
75 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
934 |
871 |
$0.00 |
| 3008F |
|
70 |
63 |
$0.00 |
| D0603 |
|
197 |
193 |
$0.00 |
| 3074F |
|
27 |
25 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
191 |
174 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D0602 |
|
325 |
310 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
27 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
59 |
$0.00 |
| 96127 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
66 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
196 |
150 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
35 |
27 |
$0.00 |
| 3725F |
|
88 |
73 |
$0.00 |
| 1160F |
|
142 |
117 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
97 |
$0.00 |
| D1110 |
Prophylaxis - adult |
205 |
178 |
$0.00 |
| D1120 |
Prophylaxis - child |
646 |
617 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
366 |
334 |
$0.00 |
| 3078F |
|
17 |
15 |
$0.00 |
| D0270 |
|
24 |
24 |
$0.00 |
| D2140 |
|
38 |
30 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
167 |
58 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
56 |
28 |
$0.00 |