| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
251 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
250 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
742 |
709 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
134 |
$22K |
| D1110 |
Prophylaxis - adult |
268 |
262 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
317 |
302 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
332 |
292 |
$12K |
| D0330 |
Panoramic radiographic image |
381 |
368 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
819 |
768 |
$9K |
| D9110 |
|
62 |
58 |
$4K |
| D0274 |
Bitewings - four radiographic images |
302 |
290 |
$4K |
| D1206 |
Topical application of fluoride varnish |
196 |
194 |
$4K |
| D2330 |
|
71 |
40 |
$4K |
| D2331 |
|
23 |
12 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
484 |
412 |
$1K |