| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,717 |
1,648 |
$201K |
| D9920 |
|
3,743 |
3,578 |
$183K |
| D1120 |
Prophylaxis - child |
4,969 |
4,932 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,813 |
1,014 |
$111K |
| D1206 |
Topical application of fluoride varnish |
6,476 |
6,432 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
5,557 |
5,517 |
$87K |
| D3120 |
|
6,035 |
2,220 |
$76K |
| D9248 |
|
833 |
806 |
$65K |
| D1110 |
Prophylaxis - adult |
1,659 |
1,646 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,813 |
1,797 |
$31K |
| D8670 |
Periodic orthodontic treatment visit |
57 |
57 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
933 |
829 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
1,015 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
456 |
269 |
$23K |
| D0240 |
|
2,320 |
1,183 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
627 |
599 |
$12K |
| D1351 |
Sealant - per tooth |
267 |
99 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
492 |
$5K |
| D0330 |
Panoramic radiographic image |
83 |
83 |
$4K |
| D0274 |
Bitewings - four radiographic images |
357 |
357 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
12 |
$3K |
| D9994 |
|
315 |
315 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
45 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64 |
26 |
$715.52 |
| D8660 |
|
14 |
14 |
$0.00 |