| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
5,182 |
4,656 |
$159K |
| D9999 |
Unspecified adjunctive procedure, by report |
3,930 |
3,797 |
$117K |
| D1206 |
Topical application of fluoride varnish |
4,305 |
4,167 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,980 |
2,942 |
$98K |
| D1120 |
Prophylaxis - child |
4,143 |
4,027 |
$97K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
386 |
105 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
985 |
931 |
$41K |
| D0240 |
|
2,590 |
1,310 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,879 |
1,831 |
$19K |
| D1351 |
Sealant - per tooth |
586 |
122 |
$15K |
| D2390 |
|
47 |
15 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
655 |
622 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,184 |
1,147 |
$10K |
| D1999 |
|
772 |
669 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
39 |
$8K |
| D0330 |
Panoramic radiographic image |
127 |
122 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
39 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,297 |
730 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
78 |
$2K |