| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
887 |
535 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,848 |
1,819 |
$73K |
| D1120 |
Prophylaxis - child |
2,063 |
2,033 |
$58K |
| D1206 |
Topical application of fluoride varnish |
1,526 |
1,502 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
123 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
94 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
199 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
303 |
284 |
$12K |
| D0274 |
Bitewings - four radiographic images |
376 |
376 |
$10K |
| D0330 |
Panoramic radiographic image |
239 |
235 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
474 |
464 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
265 |
263 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
173 |
136 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
46 |
$5K |
| D1351 |
Sealant - per tooth |
183 |
60 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
208 |
$2K |
| D0272 |
Bitewings - two radiographic images |
144 |
142 |
$2K |
| D1999 |
|
558 |
526 |
$0.00 |
| D0431 |
|
15 |
15 |
$0.00 |