| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
295 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
896 |
559 |
$34K |
| D1110 |
Prophylaxis - adult |
851 |
593 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
252 |
106 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
480 |
278 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
706 |
598 |
$19K |
| D1120 |
Prophylaxis - child |
491 |
440 |
$18K |
| D0272 |
Bitewings - two radiographic images |
613 |
485 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
466 |
415 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
31 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
85 |
62 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
77 |
63 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
126 |
89 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$60.00 |