| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,039 |
901 |
$200K |
| D0140 |
Limited oral evaluation - problem focused |
3,010 |
2,465 |
$110K |
| D1120 |
Prophylaxis - child |
2,636 |
2,300 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,508 |
2,189 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,371 |
1,148 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
202 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,117 |
1,004 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,142 |
952 |
$27K |
| D0330 |
Panoramic radiographic image |
703 |
570 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,163 |
1,719 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
289 |
120 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
864 |
416 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
45 |
$7K |
| D0272 |
Bitewings - two radiographic images |
273 |
231 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
247 |
153 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$819.00 |