| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,088 |
2,681 |
$459K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,743 |
1,140 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
674 |
577 |
$44K |
| D1110 |
Prophylaxis - adult |
821 |
819 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,179 |
1,174 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
942 |
938 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
898 |
849 |
$12K |
| D1120 |
Prophylaxis - child |
284 |
284 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
237 |
$7K |
| D2140 |
|
98 |
57 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
304 |
303 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
25 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
25 |
$2K |
| D9110 |
|
54 |
51 |
$1K |