| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,586 |
1,447 |
$171K |
| D1110 |
Prophylaxis - adult |
1,601 |
1,594 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,953 |
1,941 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,328 |
2,298 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
958 |
623 |
$75K |
| D1120 |
Prophylaxis - child |
2,019 |
2,004 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,834 |
2,998 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
1,204 |
1,201 |
$56K |
| D1206 |
Topical application of fluoride varnish |
3,474 |
3,455 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
357 |
192 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,465 |
1,449 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
226 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
240 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,030 |
1,023 |
$12K |
| D0350 |
|
863 |
506 |
$7K |
| D0330 |
Panoramic radiographic image |
190 |
190 |
$6K |
| D9430 |
|
52 |
50 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$480.00 |