| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,475 |
681 |
$118K |
| D1110 |
Prophylaxis - adult |
2,069 |
1,820 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,575 |
1,342 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,953 |
1,780 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
996 |
829 |
$45K |
| D1120 |
Prophylaxis - child |
778 |
747 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,003 |
961 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
250 |
153 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
537 |
516 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
91 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
56 |
$9K |
| D0274 |
Bitewings - four radiographic images |
455 |
375 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
431 |
355 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
29 |
$954.98 |
| D1206 |
Topical application of fluoride varnish |
38 |
37 |
$728.70 |
| D0140 |
Limited oral evaluation - problem focused |
63 |
53 |
$596.57 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
13 |
$223.56 |
| D9986 |
|
64 |
62 |
$0.00 |