| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,067 |
3,026 |
$108K |
| D1120 |
Prophylaxis - child |
2,328 |
2,301 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,950 |
1,931 |
$53K |
| D9999 |
Unspecified adjunctive procedure, by report |
501 |
487 |
$44K |
| D1110 |
Prophylaxis - adult |
382 |
379 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,843 |
1,830 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,359 |
3,295 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,089 |
1,080 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
214 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,364 |
3,029 |
$7K |
| D1351 |
Sealant - per tooth |
265 |
65 |
$6K |
| D0272 |
Bitewings - two radiographic images |
577 |
574 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
53 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
33 |
33 |
$2K |
| D9993 |
|
267 |
245 |
$2K |
| D0350 |
|
239 |
170 |
$2K |
| D1999 |
|
316 |
293 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
25 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |
| D9430 |
|
75 |
72 |
$1K |
| D1320 |
|
142 |
142 |
$1K |
| D4341 |
|
26 |
13 |
$780.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
25 |
$449.00 |
| D0603 |
|
131 |
112 |
$254.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$77.00 |
| D9986 |
|
26 |
26 |
$0.00 |
| D1310 |
|
267 |
245 |
$0.00 |
| D1330 |
|
1,498 |
1,486 |
$0.00 |