| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
625 |
357 |
$77K |
| D1110 |
Prophylaxis - adult |
1,453 |
1,260 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,601 |
1,432 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
794 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
268 |
142 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,330 |
1,264 |
$28K |
| D1120 |
Prophylaxis - child |
733 |
708 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,311 |
1,232 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
182 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
94 |
78 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
15 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
184 |
142 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
64 |
$756.47 |
| D0140 |
Limited oral evaluation - problem focused |
86 |
68 |
$615.00 |