| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,133 |
938 |
$229K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
330 |
316 |
$1K |
| D0330 |
Panoramic radiographic image |
303 |
290 |
$758.74 |
| D1206 |
Topical application of fluoride varnish |
224 |
221 |
$547.47 |
| D1110 |
Prophylaxis - adult |
128 |
128 |
$515.60 |
| D0210 |
Intraoral - complete series of radiographic images |
254 |
242 |
$484.48 |
| D0274 |
Bitewings - four radiographic images |
212 |
201 |
$363.30 |
| D1120 |
Prophylaxis - child |
80 |
80 |
$210.88 |
| D0140 |
Limited oral evaluation - problem focused |
88 |
87 |
$124.85 |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
128 |
$50.34 |
| D0120 |
Periodic oral evaluation - established patient |
53 |
53 |
$27.76 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
39 |
$0.56 |