| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
758 |
243 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,105 |
938 |
$37K |
| D1120 |
Prophylaxis - child |
944 |
841 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
676 |
582 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
162 |
76 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
121 |
60 |
$13K |
| D1206 |
Topical application of fluoride varnish |
641 |
565 |
$12K |
| D0330 |
Panoramic radiographic image |
266 |
235 |
$9K |
| D0274 |
Bitewings - four radiographic images |
395 |
347 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
520 |
403 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
547 |
434 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
16 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
100 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
50 |
41 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
46 |
$694.46 |