| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,078 |
988 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
587 |
497 |
$36K |
| D1120 |
Prophylaxis - child |
397 |
394 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
404 |
399 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
359 |
353 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
212 |
$9K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
66 |
58 |
$6K |
| D1351 |
Sealant - per tooth |
97 |
49 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
54 |
$3K |
| D1354 |
|
65 |
43 |
$2K |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$519.54 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
14 |
$90.52 |