| Code | Description | Claims | Beneficiaries | Total Paid |
| D9920 |
|
5,640 |
5,203 |
$558K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,092 |
10,049 |
$356K |
| D1110 |
Prophylaxis - adult |
6,708 |
6,690 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,448 |
2,510 |
$257K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,294 |
851 |
$239K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,356 |
2,211 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
3,136 |
3,054 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
4,964 |
4,819 |
$146K |
| D0274 |
Bitewings - four radiographic images |
4,971 |
4,940 |
$143K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,089 |
993 |
$139K |
| D1120 |
Prophylaxis - child |
3,781 |
3,760 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,673 |
5,650 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
846 |
305 |
$92K |
| D4341 |
|
732 |
304 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
874 |
739 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
5,529 |
5,368 |
$63K |
| D0330 |
Panoramic radiographic image |
1,215 |
1,189 |
$56K |
| D9222 |
|
892 |
879 |
$52K |
| D2331 |
|
387 |
273 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,802 |
1,317 |
$32K |
| D9420 |
|
396 |
358 |
$28K |
| D0272 |
Bitewings - two radiographic images |
962 |
955 |
$19K |
| D2330 |
|
186 |
118 |
$13K |
| D0240 |
|
922 |
582 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
418 |
418 |
$9K |
| D1351 |
Sealant - per tooth |
369 |
118 |
$8K |
| D2332 |
|
50 |
38 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
122 |
94 |
$3K |
| D2335 |
|
25 |
17 |
$3K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$641.02 |
| D0270 |
|
13 |
13 |
$142.87 |