| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
424 |
231 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
319 |
85 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
753 |
691 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
111 |
$26K |
| D1110 |
Prophylaxis - adult |
410 |
397 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
477 |
444 |
$17K |
| D0330 |
Panoramic radiographic image |
247 |
234 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
854 |
799 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
256 |
$9K |
| D0274 |
Bitewings - four radiographic images |
241 |
233 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
327 |
315 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
367 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
38 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
497 |
323 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$2K |
| D1120 |
Prophylaxis - child |
49 |
49 |
$2K |
| D2331 |
|
16 |
13 |
$2K |