| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,294 |
576 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,039 |
921 |
$45K |
| D1120 |
Prophylaxis - child |
1,791 |
1,715 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,896 |
2,726 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
2,558 |
2,446 |
$18K |
| D1110 |
Prophylaxis - adult |
1,087 |
1,016 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
169 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,275 |
1,197 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
401 |
368 |
$7K |
| D0272 |
Bitewings - two radiographic images |
978 |
944 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
765 |
646 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
864 |
816 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
16 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
89 |
88 |
$987.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
226 |
209 |
$652.80 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
585 |
581 |
$0.00 |