| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,460 |
1,365 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,423 |
1,327 |
$27K |
| D9920 |
|
1,213 |
1,029 |
$26K |
| D1120 |
Prophylaxis - child |
1,337 |
1,241 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
606 |
555 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
788 |
743 |
$19K |
| D2390 |
|
63 |
14 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
73 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
50 |
13 |
$8K |
| D0240 |
|
907 |
439 |
$7K |
| D0272 |
Bitewings - two radiographic images |
731 |
675 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
307 |
$6K |
| D1351 |
Sealant - per tooth |
179 |
45 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
247 |
243 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
29 |
$720.00 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$638.25 |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
34 |
$56.88 |