| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
69 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
222 |
$9K |
| D1120 |
Prophylaxis - child |
302 |
297 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
204 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
46 |
46 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$527.83 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$469.92 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$165.86 |