| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
6,551 |
5,886 |
$948K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,046 |
790 |
$523.89 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
532 |
383 |
$402.49 |
| D0330 |
Panoramic radiographic image |
1,060 |
1,049 |
$360.25 |
| D0140 |
Limited oral evaluation - problem focused |
1,815 |
1,814 |
$250.31 |
| D1110 |
Prophylaxis - adult |
983 |
983 |
$208.05 |
| D0220 |
Intraoral - periapical first radiographic image |
1,798 |
1,769 |
$198.56 |
| D0274 |
Bitewings - four radiographic images |
866 |
866 |
$117.09 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
588 |
$110.20 |
| D9430 |
|
871 |
764 |
$99.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
34 |
$53.20 |
| D0120 |
Periodic oral evaluation - established patient |
1,065 |
1,065 |
$34.44 |
| D4355 |
|
966 |
966 |
$0.00 |
| D1330 |
|
2,065 |
2,012 |
$0.00 |
| D1310 |
|
487 |
487 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
494 |
493 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
176 |
176 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
70 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
63 |
$0.00 |
| D1351 |
Sealant - per tooth |
40 |
12 |
$0.00 |
| D1354 |
|
39 |
16 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
87 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,043 |
1,040 |
$0.00 |