| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
8,710 |
7,789 |
$532K |
| D1120 |
Prophylaxis - child |
9,487 |
9,346 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,687 |
11,474 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,719 |
1,326 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
10,411 |
10,205 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,891 |
1,330 |
$170K |
| D3240 |
|
636 |
331 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,937 |
2,767 |
$87K |
| D1110 |
Prophylaxis - adult |
2,257 |
2,205 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,649 |
1,640 |
$48K |
| D1351 |
Sealant - per tooth |
1,347 |
467 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
305 |
175 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,544 |
3,418 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,699 |
1,663 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
472 |
401 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
40 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
354 |
$5K |
| D0330 |
Panoramic radiographic image |
81 |
77 |
$5K |
| D7111 |
|
219 |
151 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
290 |
264 |
$1K |
| D8660 |
|
12 |
12 |
$0.00 |