| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
2,616 |
2,526 |
$315K |
| D1110 |
Prophylaxis - adult |
1,887 |
1,869 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,020 |
2,020 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
598 |
342 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
467 |
223 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
272 |
$21K |
| D1120 |
Prophylaxis - child |
556 |
547 |
$15K |
| D0274 |
Bitewings - four radiographic images |
625 |
619 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
706 |
673 |
$13K |
| D1206 |
Topical application of fluoride varnish |
753 |
734 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
234 |
215 |
$10K |
| D1351 |
Sealant - per tooth |
316 |
72 |
$7K |
| D0272 |
Bitewings - two radiographic images |
329 |
324 |
$5K |
| D0330 |
Panoramic radiographic image |
111 |
111 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
34 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
142 |
136 |
$1K |
| D2330 |
|
22 |
12 |
$879.60 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$492.15 |
| D1330 |
|
79 |
79 |
$385.00 |
| D0601 |
|
24 |
24 |
$230.00 |