| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
41 |
$7K |
| D1120 |
Prophylaxis - child |
229 |
228 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
96 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
19 |
$4K |
| D1206 |
Topical application of fluoride varnish |
267 |
267 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
227 |
227 |
$4K |
| D9420 |
|
12 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
142 |
$2K |