| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,005 |
612 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,977 |
1,891 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
628 |
352 |
$53K |
| D1120 |
Prophylaxis - child |
1,418 |
1,397 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,987 |
1,955 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,872 |
1,845 |
$34K |
| D1110 |
Prophylaxis - adult |
634 |
612 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,342 |
2,236 |
$24K |
| D0274 |
Bitewings - four radiographic images |
768 |
749 |
$21K |
| D0272 |
Bitewings - two radiographic images |
896 |
886 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
491 |
462 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
235 |
188 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
99 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
27 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$705.15 |