| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
111 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
195 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
152 |
146 |
$4K |
| D1120 |
Prophylaxis - child |
87 |
86 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
220 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
216 |
148 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
151 |
147 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
49 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$774.28 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$303.94 |
| D0603 |
|
291 |
280 |
$0.00 |