| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
1,301 |
1,228 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
933 |
478 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,397 |
2,386 |
$43K |
| D1120 |
Prophylaxis - child |
1,518 |
1,514 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
528 |
239 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
706 |
433 |
$35K |
| D1110 |
Prophylaxis - adult |
1,046 |
1,038 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,864 |
1,854 |
$31K |
| D1351 |
Sealant - per tooth |
977 |
262 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
172 |
$15K |
| D0274 |
Bitewings - four radiographic images |
461 |
458 |
$12K |
| D1310 |
|
1,730 |
1,720 |
$9K |
| D1330 |
|
1,730 |
1,720 |
$9K |
| D0272 |
Bitewings - two radiographic images |
522 |
521 |
$8K |
| D0330 |
Panoramic radiographic image |
168 |
164 |
$5K |
| D2332 |
|
69 |
40 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
97 |
83 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
196 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
61 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
363 |
359 |
$3K |
| D0601 |
|
184 |
181 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
56 |
$720.93 |
| D0603 |
|
39 |
39 |
$370.00 |