| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
342 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,690 |
1,637 |
$66K |
| D1120 |
Prophylaxis - child |
1,962 |
1,887 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,137 |
983 |
$43K |
| D0330 |
Panoramic radiographic image |
570 |
549 |
$26K |
| D0274 |
Bitewings - four radiographic images |
744 |
710 |
$19K |
| D1206 |
Topical application of fluoride varnish |
803 |
765 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,010 |
987 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
111 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
69 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
468 |
413 |
$5K |
| D0350 |
|
210 |
205 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
177 |
171 |
$4K |
| D1351 |
Sealant - per tooth |
120 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
51 |
$810.99 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
177 |
$403.87 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
12 |
$142.68 |
| D1999 |
|
245 |
203 |
$0.00 |