| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
6,310 |
5,838 |
$366K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,467 |
2,407 |
$328K |
| D1120 |
Prophylaxis - child |
9,610 |
9,512 |
$281K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,004 |
13,863 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
12,711 |
12,591 |
$221K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,596 |
1,340 |
$152K |
| D1110 |
Prophylaxis - adult |
3,748 |
3,709 |
$145K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,924 |
2,629 |
$88K |
| D1351 |
Sealant - per tooth |
2,850 |
926 |
$79K |
| D9310 |
|
915 |
905 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
7,739 |
7,595 |
$76K |
| D0272 |
Bitewings - two radiographic images |
3,888 |
3,835 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,922 |
6,425 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
832 |
518 |
$55K |
| D1354 |
|
2,069 |
575 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
294 |
233 |
$32K |
| D3120 |
|
1,874 |
1,098 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
317 |
317 |
$23K |
| D0274 |
Bitewings - four radiographic images |
888 |
880 |
$19K |
| D9994 |
|
3,752 |
3,684 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
368 |
365 |
$10K |
| D1355 |
|
66 |
14 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
134 |
134 |
$2K |