| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
4,213 |
3,913 |
$610K |
| D0330 |
Panoramic radiographic image |
88 |
88 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,312 |
1,309 |
$0.00 |
| D1110 |
Prophylaxis - adult |
486 |
486 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
253 |
253 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
38 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,238 |
2,237 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,456 |
1,454 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
422 |
421 |
$0.00 |
| D1351 |
Sealant - per tooth |
129 |
38 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
609 |
609 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$0.00 |
| D1330 |
|
238 |
236 |
$0.00 |
| D9995 |
|
226 |
224 |
$0.00 |
| D1310 |
|
234 |
232 |
$0.00 |