| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
747 |
681 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
61 |
61 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
164 |
161 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
51 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$0.00 |
| D9310 |
|
57 |
57 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
71 |
71 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
34 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
42 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$0.00 |
| D5120 |
|
16 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
69 |
18 |
$0.00 |
| D2331 |
|
22 |
18 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
18 |
$0.00 |
| D5110 |
|
20 |
17 |
$0.00 |
| D0270 |
|
18 |
18 |
$0.00 |
| D0191 |
|
41 |
40 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
17 |
$0.00 |
| D1120 |
Prophylaxis - child |
82 |
82 |
$0.00 |
| D4341 |
|
63 |
40 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
41 |
41 |
$0.00 |
| D4910 |
|
15 |
15 |
$0.00 |
| D1110 |
Prophylaxis - adult |
98 |
97 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
50 |
$0.00 |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$0.00 |