| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
7,589 |
6,535 |
$1.61M |
| D0999 |
Unspecified diagnostic procedure, by report |
783 |
679 |
$191K |
| D1120 |
Prophylaxis - child |
2,576 |
2,547 |
$13K |
| D1206 |
Topical application of fluoride varnish |
3,503 |
3,447 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
2,404 |
2,385 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
378 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,181 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
1,350 |
1,021 |
$2K |
| D0274 |
Bitewings - four radiographic images |
876 |
865 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
244 |
$2K |
| D0330 |
Panoramic radiographic image |
889 |
880 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
760 |
743 |
$947.13 |
| D0272 |
Bitewings - two radiographic images |
384 |
378 |
$763.60 |
| D0220 |
Intraoral - periapical first radiographic image |
1,147 |
1,106 |
$521.57 |
| D0603 |
|
746 |
735 |
$185.00 |
| D0270 |
|
237 |
234 |
$72.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
610 |
173 |
$63.34 |
| D0601 |
|
86 |
86 |
$25.00 |
| D0602 |
|
44 |
44 |
$10.00 |
| D1110 |
Prophylaxis - adult |
528 |
523 |
$4.58 |
| D4910 |
|
80 |
80 |
$0.76 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$0.13 |
| D1330 |
|
252 |
251 |
$0.00 |
| D1351 |
Sealant - per tooth |
56 |
13 |
$0.00 |