| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,588 |
1,482 |
$229K |
| D0220 |
Intraoral - periapical first radiographic image |
367 |
365 |
$3.33 |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$0.00 |
| D1120 |
Prophylaxis - child |
390 |
390 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
160 |
160 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
19 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
249 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
129 |
$0.00 |
| D1330 |
|
107 |
107 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
296 |
296 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
154 |
154 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
45 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
27 |
$0.00 |