| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
920 |
842 |
$82K |
| D1110 |
Prophylaxis - adult |
437 |
436 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
887 |
887 |
$22K |
| D1120 |
Prophylaxis - child |
411 |
411 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,009 |
1,006 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
351 |
269 |
$11K |
| D0274 |
Bitewings - four radiographic images |
251 |
251 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
486 |
484 |
$6K |
| D0330 |
Panoramic radiographic image |
305 |
305 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
220 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
165 |
$2K |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
14 |
$805.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$308.00 |