| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
138 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
113 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
48 |
48 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
180 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
26 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
174 |
159 |
$4K |
| D1120 |
Prophylaxis - child |
120 |
115 |
$4K |
| D1351 |
Sealant - per tooth |
174 |
39 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
159 |
152 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
19 |
$391.34 |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
19 |
$125.60 |
| D0603 |
|
314 |
304 |
$0.00 |