| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
3,355 |
3,116 |
$225K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,923 |
1,004 |
$214K |
| D1110 |
Prophylaxis - adult |
3,170 |
3,137 |
$144K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,424 |
827 |
$123K |
| D1120 |
Prophylaxis - child |
3,638 |
3,619 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,545 |
5,513 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,640 |
5,598 |
$110K |
| D9630 |
|
4,635 |
4,613 |
$90K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,267 |
2,047 |
$75K |
| D1355 |
|
1,834 |
133 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,850 |
1,829 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
699 |
411 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,596 |
1,347 |
$41K |
| D3120 |
|
2,316 |
1,032 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
878 |
859 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
513 |
304 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,782 |
1,773 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,663 |
1,337 |
$34K |
| D2394 |
|
187 |
121 |
$24K |
| D2332 |
|
148 |
87 |
$16K |
| D0330 |
Panoramic radiographic image |
226 |
206 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
14 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
822 |
639 |
$7K |
| D2954 |
|
28 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
26 |
12 |
$839.28 |
| D1999 |
|
401 |
370 |
$0.00 |