| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
310 |
180 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
283 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
171 |
169 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
166 |
$10K |
| D1120 |
Prophylaxis - child |
103 |
102 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
92 |
91 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$292.68 |