| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
3,242 |
3,077 |
$793K |
| D0120 |
Periodic oral evaluation - established patient |
1,889 |
1,867 |
$6K |
| D1120 |
Prophylaxis - child |
897 |
889 |
$6K |
| D1206 |
Topical application of fluoride varnish |
2,194 |
2,176 |
$5K |
| D1110 |
Prophylaxis - adult |
1,020 |
1,012 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
135 |
$2K |
| D0330 |
Panoramic radiographic image |
324 |
321 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
326 |
318 |
$2K |
| D0274 |
Bitewings - four radiographic images |
633 |
631 |
$2K |
| D0272 |
Bitewings - two radiographic images |
318 |
311 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
183 |
132 |
$1K |
| D0603 |
|
521 |
518 |
$1K |
| D0601 |
|
863 |
846 |
$1K |
| D0602 |
|
693 |
686 |
$850.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
188 |
$839.97 |
| D1351 |
Sealant - per tooth |
373 |
62 |
$793.45 |
| D0220 |
Intraoral - periapical first radiographic image |
490 |
475 |
$274.09 |
| D0140 |
Limited oral evaluation - problem focused |
365 |
355 |
$245.43 |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
111 |
$47.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
194 |
102 |
$30.13 |
| D4910 |
|
335 |
332 |
$3.17 |
| D1310 |
|
183 |
181 |
$0.00 |
| D1330 |
|
2,279 |
2,260 |
$0.00 |