| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
31 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
13 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
156 |
156 |
$4K |
| D1206 |
Topical application of fluoride varnish |
134 |
134 |
$3K |
| D1120 |
Prophylaxis - child |
59 |
59 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
30 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
17 |
$0.00 |