| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
444 |
243 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
499 |
456 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
95 |
$14K |
| D0330 |
Panoramic radiographic image |
335 |
298 |
$14K |
| D1120 |
Prophylaxis - child |
491 |
461 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
126 |
$12K |
| D1110 |
Prophylaxis - adult |
276 |
254 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
663 |
630 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
344 |
342 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
74 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
212 |
185 |
$5K |
| D0240 |
|
262 |
129 |
$5K |
| D0274 |
Bitewings - four radiographic images |
214 |
191 |
$4K |
| D0272 |
Bitewings - two radiographic images |
244 |
230 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
127 |
$3K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$652.50 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
31 |
$334.40 |
| D9999 |
Unspecified adjunctive procedure, by report |
203 |
123 |
$0.00 |