| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,261 |
663 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,413 |
1,402 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,438 |
1,432 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
983 |
972 |
$36K |
| D1120 |
Prophylaxis - child |
1,163 |
1,149 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,460 |
1,699 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
234 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,626 |
1,608 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
338 |
154 |
$19K |
| D0274 |
Bitewings - four radiographic images |
924 |
921 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,187 |
1,163 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
29 |
$6K |
| D9430 |
|
79 |
74 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
28 |
$1K |
| D9993 |
|
16 |
16 |
$1K |
| D1310 |
|
16 |
16 |
$736.00 |
| D1999 |
|
67 |
62 |
$360.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$336.00 |