| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
610 |
277 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
707 |
679 |
$23K |
| D1110 |
Prophylaxis - adult |
549 |
541 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,275 |
1,189 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
404 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
69 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
226 |
$8K |
| D0274 |
Bitewings - four radiographic images |
358 |
355 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
305 |
303 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
26 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
612 |
602 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
49 |
$6K |
| D1120 |
Prophylaxis - child |
149 |
141 |
$5K |
| D0603 |
|
540 |
518 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
381 |
374 |
$2K |
| D0330 |
Panoramic radiographic image |
79 |
71 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
94 |
$2K |
| D0601 |
|
97 |
94 |
$900.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$142.70 |