| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
158 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
331 |
$11K |
| D1110 |
Prophylaxis - adult |
209 |
207 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
104 |
$9K |
| D1120 |
Prophylaxis - child |
94 |
94 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
64 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
140 |
$4K |
| D0274 |
Bitewings - four radiographic images |
127 |
127 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
50 |
$3K |
| D1206 |
Topical application of fluoride varnish |
158 |
158 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
97 |
97 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
251 |
$2K |
| D2332 |
|
24 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
36 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$682.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
29 |
$309.17 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$218.40 |