| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
4,050 |
3,564 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,098 |
736 |
$154K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
830 |
278 |
$87K |
| D1120 |
Prophylaxis - child |
2,919 |
2,887 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,588 |
3,551 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,519 |
363 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,310 |
1,146 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
637 |
344 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,242 |
1,224 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,366 |
2,341 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
978 |
911 |
$15K |
| D0272 |
Bitewings - two radiographic images |
959 |
949 |
$13K |
| D0330 |
Panoramic radiographic image |
177 |
170 |
$7K |
| D1110 |
Prophylaxis - adult |
198 |
192 |
$7K |
| D9994 |
|
1,685 |
1,660 |
$7K |
| D9992 |
|
1,125 |
1,104 |
$5K |
| D9630 |
|
486 |
482 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
557 |
538 |
$4K |
| D0274 |
Bitewings - four radiographic images |
167 |
167 |
$4K |
| D4346 |
|
164 |
164 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
229 |
109 |
$2K |
| D0240 |
|
173 |
105 |
$69.60 |
| D3120 |
|
22 |
12 |
$0.00 |