| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
365 |
364 |
$728K |
| D9920 |
|
3,721 |
3,637 |
$423K |
| D1110 |
Prophylaxis - adult |
2,886 |
2,868 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,552 |
3,526 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,492 |
1,477 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
110 |
$19K |
| D1206 |
Topical application of fluoride varnish |
600 |
596 |
$13K |
| D1120 |
Prophylaxis - child |
350 |
348 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
60 |
$7K |
| D0330 |
Panoramic radiographic image |
107 |
105 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
44 |
$6K |
| D0272 |
Bitewings - two radiographic images |
226 |
225 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
518 |
514 |
$5K |
| D1351 |
Sealant - per tooth |
124 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
326 |
290 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$2K |