| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
2,586 |
2,208 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
456 |
286 |
$41K |
| D1110 |
Prophylaxis - adult |
1,032 |
1,031 |
$34K |
| D1120 |
Prophylaxis - child |
1,180 |
1,173 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,791 |
1,783 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
954 |
821 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
374 |
250 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,640 |
1,634 |
$23K |
| D2335 |
|
166 |
98 |
$23K |
| D2332 |
|
176 |
90 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
517 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
128 |
$14K |
| D9994 |
|
2,081 |
1,882 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,755 |
1,571 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,653 |
1,595 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
380 |
$9K |
| D9992 |
|
1,162 |
1,086 |
$7K |
| D0272 |
Bitewings - two radiographic images |
328 |
326 |
$6K |
| D1351 |
Sealant - per tooth |
168 |
53 |
$5K |
| D0274 |
Bitewings - four radiographic images |
286 |
286 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
91 |
$2K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |
| D3120 |
|
144 |
84 |
$1K |