| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
616 |
234 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,069 |
770 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
81 |
27 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
780 |
755 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
155 |
$21K |
| D1120 |
Prophylaxis - child |
517 |
498 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
196 |
96 |
$14K |
| D1110 |
Prophylaxis - adult |
252 |
246 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
859 |
825 |
$12K |
| D0274 |
Bitewings - four radiographic images |
373 |
359 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
839 |
808 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
291 |
271 |
$7K |
| D1351 |
Sealant - per tooth |
289 |
79 |
$6K |
| D0272 |
Bitewings - two radiographic images |
127 |
121 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
22 |
$741.72 |
| D0601 |
|
150 |
145 |
$0.00 |
| D0602 |
|
134 |
123 |
$0.00 |
| D0603 |
|
805 |
784 |
$0.00 |