| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
128 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
428 |
428 |
$18K |
| D1120 |
Prophylaxis - child |
398 |
398 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
93 |
$14K |
| D1206 |
Topical application of fluoride varnish |
445 |
444 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
174 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
57 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
384 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
217 |
133 |
$2K |
| D0272 |
Bitewings - two radiographic images |
82 |
82 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$2K |
| D9920 |
|
31 |
27 |
$1K |
| D1351 |
Sealant - per tooth |
28 |
12 |
$929.88 |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$836.26 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$420.40 |
| D0270 |
|
17 |
14 |
$66.22 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
60 |
$0.00 |