| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,006 |
961 |
$183K |
| D1120 |
Prophylaxis - child |
2,766 |
2,752 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,860 |
3,830 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,720 |
2,692 |
$57K |
| D1110 |
Prophylaxis - adult |
1,229 |
1,222 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,444 |
1,439 |
$43K |
| D0330 |
Panoramic radiographic image |
796 |
794 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,577 |
1,561 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
746 |
733 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
145 |
69 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
477 |
477 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,308 |
668 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
260 |
235 |
$7K |
| D0603 |
|
593 |
593 |
$5K |
| D0602 |
|
536 |
536 |
$5K |
| D0272 |
Bitewings - two radiographic images |
227 |
227 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
16 |
$1K |
| D0601 |
|
87 |
87 |
$795.61 |