| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
541 |
191 |
$59K |
| D1120 |
Prophylaxis - child |
971 |
952 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,332 |
1,312 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,294 |
$39K |
| D1110 |
Prophylaxis - adult |
239 |
232 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
51 |
$16K |
| D0274 |
Bitewings - four radiographic images |
98 |
98 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
124 |
$3K |
| D0272 |
Bitewings - two radiographic images |
32 |
31 |
$966.00 |