| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
44 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
144 |
$4K |
| D1120 |
Prophylaxis - child |
114 |
110 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
209 |
$3K |
| D0274 |
Bitewings - four radiographic images |
96 |
93 |
$2K |
| D1110 |
Prophylaxis - adult |
53 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
174 |
167 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
179 |
160 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
64 |
$2K |
| D1351 |
Sealant - per tooth |
52 |
15 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
16 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$777.04 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$773.51 |
| D0603 |
|
168 |
161 |
$0.03 |
| D0602 |
|
89 |
89 |
$0.00 |