| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
6,351 |
5,647 |
$912K |
| D1110 |
Prophylaxis - adult |
1,347 |
1,347 |
$218.24 |
| D0274 |
Bitewings - four radiographic images |
1,050 |
1,050 |
$81.51 |
| D0120 |
Periodic oral evaluation - established patient |
1,927 |
1,883 |
$81.23 |
| D0140 |
Limited oral evaluation - problem focused |
1,912 |
1,912 |
$67.99 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
252 |
$42.78 |
| D0330 |
Panoramic radiographic image |
254 |
253 |
$38.50 |
| D0220 |
Intraoral - periapical first radiographic image |
946 |
922 |
$33.99 |
| D7140 |
Extraction, erupted tooth or exposed root |
264 |
184 |
$28.50 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
459 |
390 |
$19.95 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
309 |
237 |
$13.06 |
| D1320 |
|
144 |
143 |
$2.38 |
| D0270 |
|
76 |
76 |
$0.00 |
| D9440 |
|
425 |
403 |
$0.00 |
| D1330 |
|
1,284 |
1,281 |
$0.00 |