| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
94 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
281 |
263 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
484 |
240 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
140 |
127 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
277 |
256 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
326 |
273 |
$3K |
| D0274 |
Bitewings - four radiographic images |
101 |
84 |
$3K |
| D1120 |
Prophylaxis - child |
83 |
78 |
$3K |
| D1110 |
Prophylaxis - adult |
49 |
39 |
$2K |
| D0272 |
Bitewings - two radiographic images |
44 |
42 |
$888.44 |
| D0603 |
|
278 |
264 |
$0.00 |