| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
844 |
652 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
308 |
127 |
$12K |
| D0272 |
Bitewings - two radiographic images |
532 |
420 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
245 |
202 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
358 |
283 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
687 |
538 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
735 |
571 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
116 |
43 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
624 |
492 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
183 |
152 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
42 |
$1K |
| D9310 |
|
33 |
26 |
$960.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$914.05 |
| D1206 |
Topical application of fluoride varnish |
51 |
32 |
$910.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
46 |
$861.00 |
| D9420 |
|
30 |
14 |
$532.87 |
| D0350 |
|
28 |
13 |
$225.50 |