| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
805 |
716 |
$196K |
| D0999 |
Unspecified diagnostic procedure, by report |
584 |
320 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
118 |
$5K |
| D1120 |
Prophylaxis - child |
636 |
526 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
500 |
395 |
$3K |
| D1206 |
Topical application of fluoride varnish |
628 |
514 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
374 |
322 |
$796.42 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
38 |
$770.64 |
| D0330 |
Panoramic radiographic image |
148 |
116 |
$650.75 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
120 |
$529.21 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
36 |
$462.85 |
| D0274 |
Bitewings - four radiographic images |
91 |
89 |
$390.50 |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
302 |
$247.75 |
| D0272 |
Bitewings - two radiographic images |
116 |
80 |
$145.05 |
| D1354 |
|
29 |
12 |
$39.96 |
| D0603 |
|
90 |
89 |
$35.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$0.50 |
| D1351 |
Sealant - per tooth |
41 |
12 |
$0.38 |
| D0270 |
|
13 |
13 |
$0.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$0.04 |
| D0601 |
|
106 |
103 |
$0.00 |
| D1330 |
|
235 |
228 |
$0.00 |
| D1310 |
|
110 |
108 |
$0.00 |