| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
407 |
155 |
$34K |
| D9920 |
|
646 |
478 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
198 |
100 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
644 |
432 |
$16K |
| D1206 |
Topical application of fluoride varnish |
792 |
781 |
$12K |
| D1120 |
Prophylaxis - child |
487 |
479 |
$11K |
| D9630 |
|
542 |
523 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
652 |
645 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
40 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
170 |
$6K |
| D0274 |
Bitewings - four radiographic images |
278 |
274 |
$5K |
| D1110 |
Prophylaxis - adult |
141 |
140 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
143 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
313 |
$2K |
| D2394 |
|
26 |
13 |
$2K |
| D0240 |
|
225 |
181 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
185 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
27 |
$621.66 |