| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
4,256 |
3,688 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,584 |
1,371 |
$168K |
| D1120 |
Prophylaxis - child |
4,022 |
3,997 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,995 |
2,653 |
$76K |
| D1206 |
Topical application of fluoride varnish |
4,418 |
4,386 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
733 |
455 |
$60K |
| D9310 |
|
786 |
783 |
$55K |
| D9630 |
|
3,603 |
3,563 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,672 |
3,644 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
664 |
429 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,232 |
1,225 |
$32K |
| D1110 |
Prophylaxis - adult |
796 |
789 |
$26K |
| D0240 |
|
2,764 |
1,392 |
$26K |
| D0330 |
Panoramic radiographic image |
645 |
635 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,417 |
1,409 |
$19K |
| D1351 |
Sealant - per tooth |
817 |
289 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
392 |
278 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,932 |
1,873 |
$15K |
| D3120 |
|
912 |
506 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
529 |
529 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,194 |
1,143 |
$9K |
| D8660 |
|
32 |
32 |
$8K |
| D0274 |
Bitewings - four radiographic images |
341 |
339 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
340 |
334 |
$6K |
| D9994 |
|
1,679 |
1,651 |
$989.92 |