| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
5,017 |
4,746 |
$301K |
| D1120 |
Prophylaxis - child |
8,254 |
8,170 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,748 |
1,601 |
$200K |
| D1206 |
Topical application of fluoride varnish |
11,208 |
11,093 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
9,980 |
9,878 |
$170K |
| D1110 |
Prophylaxis - adult |
2,807 |
2,779 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,548 |
3,258 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,653 |
1,163 |
$97K |
| D1351 |
Sealant - per tooth |
3,156 |
1,029 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,483 |
3,448 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,093 |
1,081 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
531 |
318 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,111 |
3,011 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,296 |
1,277 |
$28K |
| D0240 |
|
2,165 |
1,084 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,809 |
1,384 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
96 |
68 |
$14K |
| D4346 |
|
140 |
137 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
50 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
239 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
30 |
$4K |
| D0330 |
Panoramic radiographic image |
241 |
232 |
$2K |
| D3120 |
|
254 |
148 |
$1K |
| D1354 |
|
102 |
28 |
$528.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$517.67 |