| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
2,630 |
2,489 |
$591K |
| D0999 |
Unspecified diagnostic procedure, by report |
218 |
209 |
$58K |
| D1120 |
Prophylaxis - child |
718 |
716 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,392 |
1,381 |
$5K |
| D1206 |
Topical application of fluoride varnish |
1,592 |
1,583 |
$4K |
| D0603 |
|
1,091 |
1,084 |
$2K |
| D1110 |
Prophylaxis - adult |
815 |
809 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
93 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
187 |
$1K |
| D0272 |
Bitewings - two radiographic images |
171 |
171 |
$937.09 |
| D0274 |
Bitewings - four radiographic images |
386 |
386 |
$790.26 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
41 |
$709.72 |
| D1351 |
Sealant - per tooth |
218 |
40 |
$491.12 |
| D0602 |
|
268 |
267 |
$175.00 |
| D0140 |
Limited oral evaluation - problem focused |
163 |
162 |
$148.23 |
| D0601 |
|
199 |
195 |
$105.00 |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
158 |
$9.48 |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$0.16 |
| D1330 |
|
1,753 |
1,742 |
$0.00 |
| D1310 |
|
543 |
538 |
$0.00 |