| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,092 |
684 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
957 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
727 |
362 |
$47K |
| D1120 |
Prophylaxis - child |
556 |
551 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
458 |
458 |
$21K |
| D9430 |
|
491 |
463 |
$15K |
| D2330 |
|
163 |
73 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
731 |
725 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
121 |
121 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,570 |
738 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
47 |
$5K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
396 |
388 |
$5K |
| D2332 |
|
54 |
16 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
88 |
$4K |
| D0330 |
Panoramic radiographic image |
68 |
67 |
$2K |
| D0274 |
Bitewings - four radiographic images |
102 |
100 |
$2K |
| D0272 |
Bitewings - two radiographic images |
99 |
94 |
$1K |
| D2140 |
|
20 |
12 |
$1K |
| D0270 |
|
76 |
69 |
$365.00 |
| D0431 |
|
303 |
294 |
$0.00 |