| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
239 |
199 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
148 |
$598.19 |
| D1120 |
Prophylaxis - child |
133 |
133 |
$522.37 |
| D0330 |
Panoramic radiographic image |
77 |
77 |
$379.64 |
| D1206 |
Topical application of fluoride varnish |
157 |
156 |
$353.55 |
| D0274 |
Bitewings - four radiographic images |
42 |
42 |
$86.56 |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
13 |
$0.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
59 |
59 |
$0.16 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
13 |
$0.00 |