| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
2,084 |
2,036 |
$152K |
| D9999 |
Unspecified adjunctive procedure, by report |
219 |
218 |
$16K |
| D1120 |
Prophylaxis - child |
1,404 |
1,402 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
1,294 |
1,292 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
375 |
269 |
$2K |
| D1351 |
Sealant - per tooth |
474 |
203 |
$2K |
| D0272 |
Bitewings - two radiographic images |
980 |
978 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,084 |
1,077 |
$1K |
| D1206 |
Topical application of fluoride varnish |
508 |
508 |
$1K |
| D1999 |
|
24 |
24 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
160 |
$606.68 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
153 |
136 |
$377.43 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$146.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
628 |
625 |
$106.63 |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$51.30 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$13.30 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |