| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
2,580 |
2,312 |
$629K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,149 |
$3K |
| D1110 |
Prophylaxis - adult |
796 |
788 |
$3K |
| D1206 |
Topical application of fluoride varnish |
1,360 |
1,346 |
$2K |
| D1120 |
Prophylaxis - child |
415 |
412 |
$2K |
| D1351 |
Sealant - per tooth |
472 |
92 |
$2K |
| D0274 |
Bitewings - four radiographic images |
610 |
609 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
868 |
448 |
$785.40 |
| D0330 |
Panoramic radiographic image |
355 |
345 |
$770.45 |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
132 |
$546.69 |
| D0603 |
|
440 |
435 |
$525.00 |
| D0601 |
|
308 |
306 |
$465.00 |
| D0602 |
|
175 |
172 |
$360.01 |
| D0140 |
Limited oral evaluation - problem focused |
419 |
398 |
$280.78 |
| D0220 |
Intraoral - periapical first radiographic image |
540 |
511 |
$162.93 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$88.41 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$11.21 |
| D1330 |
|
1,306 |
1,293 |
$0.01 |
| D1310 |
|
761 |
755 |
$0.00 |