| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
697 |
258 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
379 |
168 |
$33K |
| D2332 |
|
142 |
74 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
446 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
564 |
564 |
$11K |
| D1110 |
Prophylaxis - adult |
210 |
210 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
429 |
$7K |
| D0274 |
Bitewings - four radiographic images |
195 |
195 |
$6K |
| D1120 |
Prophylaxis - child |
126 |
126 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
395 |
$3K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$203.04 |