| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
6,853 |
5,587 |
$2.21M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,210 |
1,104 |
$736K |
| D1206 |
Topical application of fluoride varnish |
3,539 |
3,166 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
2,665 |
2,434 |
$3K |
| D1120 |
Prophylaxis - child |
1,197 |
1,055 |
$2K |
| D1110 |
Prophylaxis - adult |
1,237 |
1,162 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
192 |
$2K |
| D0274 |
Bitewings - four radiographic images |
695 |
664 |
$661.01 |
| D0140 |
Limited oral evaluation - problem focused |
263 |
233 |
$308.14 |
| D0330 |
Panoramic radiographic image |
166 |
155 |
$274.79 |
| D1354 |
|
78 |
36 |
$125.34 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
99 |
86 |
$104.49 |
| D0272 |
Bitewings - two radiographic images |
78 |
66 |
$43.81 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
58 |
$21.95 |
| D0220 |
Intraoral - periapical first radiographic image |
340 |
322 |
$8.00 |
| D1351 |
Sealant - per tooth |
156 |
41 |
$7.87 |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
36 |
$1.10 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$0.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
40 |
$0.06 |
| D1330 |
|
16 |
16 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
108 |
$0.00 |