| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
188 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
372 |
312 |
$13K |
| D1120 |
Prophylaxis - child |
319 |
314 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
333 |
327 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
358 |
353 |
$7K |
| D1110 |
Prophylaxis - adult |
134 |
132 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
53 |
$5K |
| D0272 |
Bitewings - two radiographic images |
233 |
231 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
75 |
71 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$190.97 |