| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
1,056 |
986 |
$70K |
| D1110 |
Prophylaxis - adult |
1,803 |
1,767 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,244 |
3,175 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,010 |
2,945 |
$57K |
| D1120 |
Prophylaxis - child |
1,521 |
1,481 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,689 |
1,645 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
250 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
144 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
968 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
874 |
756 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
155 |
132 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
111 |
105 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
98 |
$3K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D9630 |
|
95 |
90 |
$1K |
| D4910 |
|
26 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
35 |
15 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$322.79 |