| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
16,849 |
14,425 |
$3.41M |
| D0999 |
Unspecified diagnostic procedure, by report |
1,898 |
1,616 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
5,025 |
4,966 |
$17K |
| D1206 |
Topical application of fluoride varnish |
6,505 |
6,418 |
$16K |
| D1110 |
Prophylaxis - adult |
3,613 |
3,561 |
$11K |
| D1120 |
Prophylaxis - child |
1,613 |
1,598 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,751 |
1,721 |
$6K |
| D0603 |
|
2,045 |
1,992 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,882 |
1,859 |
$5K |
| D0602 |
|
1,570 |
1,536 |
$3K |
| D0601 |
|
2,012 |
1,991 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
305 |
$3K |
| D0330 |
Panoramic radiographic image |
586 |
575 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
1,526 |
1,419 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
388 |
288 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,722 |
1,317 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
2,803 |
2,681 |
$2K |
| D0272 |
Bitewings - two radiographic images |
298 |
298 |
$1K |
| D1351 |
Sealant - per tooth |
827 |
119 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
3,118 |
2,978 |
$922.57 |
| D1208 |
Topical application of fluoride, excluding varnish |
128 |
125 |
$425.13 |
| D0230 |
Intraoral - periapical each additional radiographic image |
93 |
52 |
$80.86 |
| D4910 |
|
463 |
452 |
$4.20 |
| D4341 |
|
37 |
13 |
$0.33 |
| D2940 |
|
37 |
24 |
$0.18 |
| D1330 |
|
6,380 |
6,289 |
$0.00 |
| D9995 |
|
111 |
107 |
$0.00 |