| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
3,096 |
2,876 |
$764K |
| D1120 |
Prophylaxis - child |
1,025 |
1,019 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
1,869 |
1,850 |
$5K |
| D1206 |
Topical application of fluoride varnish |
2,095 |
2,072 |
$5K |
| D1110 |
Prophylaxis - adult |
843 |
828 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
242 |
193 |
$3K |
| D0274 |
Bitewings - four radiographic images |
746 |
743 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
136 |
$971.43 |
| D0601 |
|
910 |
899 |
$875.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
80 |
$595.69 |
| D0602 |
|
468 |
461 |
$565.00 |
| D0603 |
|
539 |
534 |
$520.00 |
| D0272 |
Bitewings - two radiographic images |
94 |
92 |
$511.10 |
| D0220 |
Intraoral - periapical first radiographic image |
542 |
516 |
$384.86 |
| D0330 |
Panoramic radiographic image |
55 |
54 |
$188.27 |
| D0140 |
Limited oral evaluation - problem focused |
348 |
337 |
$184.17 |
| D7140 |
Extraction, erupted tooth or exposed root |
177 |
88 |
$120.64 |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
56 |
$1.71 |
| D1330 |
|
1,941 |
1,918 |
$0.00 |
| D1310 |
|
923 |
917 |
$0.00 |