| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
593 |
504 |
$54K |
| D9999 |
Unspecified adjunctive procedure, by report |
53 |
51 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
234 |
228 |
$804.13 |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$534.25 |
| D1120 |
Prophylaxis - child |
221 |
212 |
$336.70 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
35 |
$310.00 |
| D1206 |
Topical application of fluoride varnish |
271 |
261 |
$258.56 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
40 |
$213.70 |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
105 |
$172.97 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$106.85 |
| D0330 |
Panoramic radiographic image |
29 |
28 |
$22.60 |
| D0603 |
|
19 |
18 |
$20.00 |
| D0272 |
Bitewings - two radiographic images |
70 |
68 |
$18.80 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$0.12 |
| D0274 |
Bitewings - four radiographic images |
36 |
33 |
$0.00 |
| D1310 |
|
38 |
38 |
$0.00 |
| D1330 |
|
39 |
39 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |