| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
6,460 |
5,638 |
$1.27M |
| D0120 |
Periodic oral evaluation - established patient |
2,883 |
2,851 |
$32K |
| D1206 |
Topical application of fluoride varnish |
2,480 |
2,453 |
$21K |
| D1110 |
Prophylaxis - adult |
1,878 |
1,852 |
$16K |
| D1120 |
Prophylaxis - child |
780 |
770 |
$15K |
| D0274 |
Bitewings - four radiographic images |
751 |
740 |
$5K |
| D0603 |
|
1,374 |
1,344 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
91 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
234 |
158 |
$2K |
| D0601 |
|
914 |
906 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
242 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
172 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
599 |
571 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
67 |
$961.51 |
| D0272 |
Bitewings - two radiographic images |
140 |
138 |
$859.64 |
| D0602 |
|
519 |
514 |
$725.00 |
| D1351 |
Sealant - per tooth |
147 |
29 |
$653.47 |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
515 |
$513.82 |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$456.30 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
14 |
$94.17 |
| D4910 |
|
92 |
92 |
$0.85 |
| D1330 |
|
3,072 |
3,031 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |