| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
148 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
97 |
$14K |
| D1120 |
Prophylaxis - child |
250 |
231 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
154 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
26 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
17 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
117 |
98 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
63 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$714.99 |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
50 |
$462.80 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$405.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$276.17 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$223.24 |
| D1999 |
|
15 |
15 |
$0.00 |