| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
647 |
568 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
733 |
305 |
$43K |
| D1110 |
Prophylaxis - adult |
946 |
936 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,042 |
1,031 |
$28K |
| D1351 |
Sealant - per tooth |
1,060 |
113 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
830 |
820 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
129 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,048 |
984 |
$8K |
| D0330 |
Panoramic radiographic image |
219 |
218 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
891 |
852 |
$7K |
| D1320 |
|
378 |
330 |
$6K |
| D1330 |
|
646 |
643 |
$6K |
| D1310 |
|
605 |
602 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
127 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
250 |
250 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
263 |
261 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
16 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
24 |
$3K |
| D2330 |
|
52 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
57 |
57 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
21 |
$978.00 |
| D9110 |
|
21 |
19 |
$662.00 |
| D0602 |
|
14 |
14 |
$130.00 |
| D0603 |
|
15 |
14 |
$0.00 |