| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,501 |
1,160 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
347 |
154 |
$24K |
| D1120 |
Prophylaxis - child |
662 |
623 |
$17K |
| D1206 |
Topical application of fluoride varnish |
703 |
661 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
652 |
620 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
188 |
63 |
$11K |
| D1110 |
Prophylaxis - adult |
325 |
307 |
$11K |
| D0330 |
Panoramic radiographic image |
93 |
83 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
82 |
$2K |
| D0272 |
Bitewings - two radiographic images |
64 |
60 |
$1K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$878.40 |