| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
3,956 |
3,159 |
$627K |
| D1206 |
Topical application of fluoride varnish |
160 |
160 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
541 |
270 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
456 |
452 |
$0.00 |
| D2331 |
|
157 |
118 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
46 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
178 |
178 |
$0.00 |
| D0470 |
|
58 |
53 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
303 |
299 |
$0.00 |
| D1351 |
Sealant - per tooth |
360 |
125 |
$0.00 |
| D4342 |
|
81 |
51 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
249 |
$0.00 |
| D2330 |
|
66 |
44 |
$0.00 |
| D9310 |
|
319 |
302 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
805 |
788 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
205 |
204 |
$0.00 |
| D5214 |
|
112 |
83 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$0.00 |
| D5120 |
|
64 |
44 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
19 |
15 |
$0.00 |
| D4910 |
|
93 |
88 |
$0.00 |
| D5213 |
|
15 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
317 |
317 |
$0.00 |
| D1110 |
Prophylaxis - adult |
544 |
531 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
249 |
249 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
142 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
44 |
29 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
91 |
$0.00 |
| D4341 |
|
298 |
151 |
$0.00 |
| D0270 |
|
86 |
86 |
$0.00 |
| D9430 |
|
14 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
240 |
240 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
322 |
320 |
$0.00 |
| D5110 |
|
114 |
84 |
$0.00 |
| D0191 |
|
17 |
17 |
$0.00 |