| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
321 |
274 |
$96K |
| D5110 |
|
90 |
90 |
$46K |
| D9410 |
|
318 |
271 |
$40K |
| D9999 |
Unspecified adjunctive procedure, by report |
156 |
153 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,300 |
3,287 |
$33K |
| D1110 |
Prophylaxis - adult |
1,032 |
1,027 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
2,697 |
2,691 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
777 |
769 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
476 |
476 |
$6K |
| D9932 |
|
71 |
71 |
$6K |
| D4341 |
|
2,185 |
1,031 |
$6K |
| D1206 |
Topical application of fluoride varnish |
1,204 |
1,203 |
$5K |
| D0350 |
|
2,173 |
2,164 |
$2K |
| D1330 |
|
919 |
915 |
$2K |
| D4921 |
|
94 |
28 |
$1K |
| D9933 |
|
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
331 |
331 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,037 |
1,008 |
$849.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,580 |
583 |
$121.50 |
| D9996 |
|
394 |
389 |
$84.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,257 |
807 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
26 |
$0.00 |
| D9450 |
|
37 |
37 |
$0.00 |
| D0170 |
|
27 |
27 |
$0.00 |
| D9912 |
|
2,499 |
2,122 |
$0.00 |
| D5214 |
|
143 |
141 |
$0.00 |
| D0603 |
|
139 |
138 |
$0.00 |
| D5120 |
|
13 |
13 |
$0.00 |
| D0171 |
|
21 |
21 |
$0.00 |
| D0708 |
|
24 |
23 |
$0.00 |
| D9986 |
|
2,759 |
2,647 |
$0.00 |
| D0351 |
|
131 |
131 |
$0.00 |
| D0191 |
|
587 |
585 |
$0.00 |
| D9430 |
|
355 |
352 |
$0.00 |
| D1354 |
|
368 |
173 |
$0.00 |
| D5213 |
|
13 |
13 |
$0.00 |
| D0190 |
|
164 |
163 |
$0.00 |
| D4910 |
|
28 |
28 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
15 |
$0.00 |