| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
5,491 |
5,335 |
$794K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
433 |
287 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
261 |
150 |
$3K |
| D1120 |
Prophylaxis - child |
3,376 |
3,376 |
$653.60 |
| D0120 |
Periodic oral evaluation - established patient |
3,226 |
3,226 |
$358.15 |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
888 |
$177.65 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,090 |
3,084 |
$159.60 |
| D0272 |
Bitewings - two radiographic images |
2,196 |
2,194 |
$96.90 |
| D1206 |
Topical application of fluoride varnish |
181 |
179 |
$85.50 |
| D0274 |
Bitewings - four radiographic images |
445 |
445 |
$27.55 |
| D0330 |
Panoramic radiographic image |
440 |
440 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
521 |
508 |
$0.00 |
| D0191 |
|
39 |
39 |
$0.00 |
| D1354 |
|
274 |
83 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
262 |
$0.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
473 |
473 |
$0.00 |
| D0603 |
|
3,149 |
3,149 |
$0.00 |
| D1330 |
|
1,398 |
1,398 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,096 |
378 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
122 |
122 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
482 |
385 |
$0.00 |