| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
494 |
282 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
812 |
801 |
$17K |
| D1120 |
Prophylaxis - child |
547 |
537 |
$16K |
| D1110 |
Prophylaxis - adult |
308 |
305 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
303 |
274 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
68 |
$5K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$4K |
| D0272 |
Bitewings - two radiographic images |
154 |
152 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
42 |
$714.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$476.00 |