| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
3,800 |
3,180 |
$382K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,428 |
690 |
$99K |
| D1351 |
Sealant - per tooth |
2,294 |
382 |
$84K |
| D1110 |
Prophylaxis - adult |
2,282 |
2,269 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,535 |
2,522 |
$67K |
| D1354 |
|
2,315 |
238 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
860 |
392 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,657 |
1,652 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
529 |
178 |
$36K |
| D0330 |
Panoramic radiographic image |
886 |
884 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,095 |
1,084 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,109 |
1,107 |
$24K |
| D1320 |
|
1,507 |
1,230 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
541 |
$22K |
| D1330 |
|
2,793 |
2,776 |
$21K |
| D1310 |
|
2,791 |
2,775 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,155 |
2,066 |
$16K |
| D1120 |
Prophylaxis - child |
471 |
469 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,987 |
1,924 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
203 |
122 |
$13K |
| D2332 |
|
186 |
84 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
285 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$7K |
| D5214 |
|
14 |
13 |
$7K |
| D5110 |
|
13 |
12 |
$6K |
| D4341 |
|
49 |
35 |
$5K |
| D2330 |
|
84 |
27 |
$5K |
| D0603 |
|
628 |
624 |
$5K |
| D2950 |
|
17 |
17 |
$1K |
| D2954 |
|
13 |
12 |
$1K |