| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,613 |
1,268 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
4,288 |
4,123 |
$109K |
| D1120 |
Prophylaxis - child |
3,105 |
2,958 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,031 |
516 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,226 |
4,052 |
$68K |
| D1110 |
Prophylaxis - adult |
1,796 |
1,728 |
$66K |
| D0272 |
Bitewings - two radiographic images |
1,779 |
1,698 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
545 |
517 |
$19K |
| D0274 |
Bitewings - four radiographic images |
175 |
170 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
110 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$490.20 |