| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
24,374 |
23,439 |
$719K |
| D0120 |
Periodic oral evaluation - established patient |
21,943 |
21,630 |
$622K |
| D1120 |
Prophylaxis - child |
23,211 |
22,839 |
$556K |
| D1206 |
Topical application of fluoride varnish |
23,109 |
22,727 |
$493K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,845 |
2,697 |
$421K |
| D9999 |
Unspecified adjunctive procedure, by report |
9,518 |
9,361 |
$278K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,614 |
7,398 |
$167K |
| D0272 |
Bitewings - two radiographic images |
15,593 |
15,331 |
$157K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,024 |
315 |
$154K |
| D1351 |
Sealant - per tooth |
4,574 |
1,467 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
4,625 |
4,295 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,338 |
2,263 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,113 |
604 |
$63K |
| D0330 |
Panoramic radiographic image |
1,620 |
1,599 |
$63K |
| D1999 |
|
2,841 |
2,736 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
535 |
355 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,139 |
2,082 |
$18K |
| D0240 |
|
1,713 |
863 |
$15K |
| D1110 |
Prophylaxis - adult |
273 |
267 |
$10K |
| D0274 |
Bitewings - four radiographic images |
242 |
234 |
$3K |
| D9630 |
|
13 |
13 |
$585.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
137 |
$428.97 |