| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,448 |
1,297 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,066 |
$31K |
| D1110 |
Prophylaxis - adult |
528 |
527 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
553 |
404 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
508 |
242 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
285 |
$13K |
| D0274 |
Bitewings - four radiographic images |
239 |
239 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
674 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
429 |
429 |
$5K |
| D1120 |
Prophylaxis - child |
153 |
153 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
129 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
145 |
$1K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$650.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$0.00 |