| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
956 |
501 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
1,700 |
1,664 |
$43K |
| D1110 |
Prophylaxis - adult |
1,070 |
1,030 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
373 |
133 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,156 |
1,631 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,320 |
2,163 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
640 |
603 |
$27K |
| D0274 |
Bitewings - four radiographic images |
805 |
774 |
$25K |
| D1120 |
Prophylaxis - child |
912 |
891 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,351 |
1,321 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
589 |
$22K |
| D0330 |
Panoramic radiographic image |
367 |
351 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
63 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
81 |
$10K |
| D0272 |
Bitewings - two radiographic images |
155 |
148 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
108 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$1K |
| D1999 |
|
17 |
17 |
$0.00 |