| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
405 |
393 |
$20K |
| D1120 |
Prophylaxis - child |
491 |
478 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
647 |
631 |
$16K |
| D1206 |
Topical application of fluoride varnish |
684 |
669 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
100 |
$8K |
| D0274 |
Bitewings - four radiographic images |
111 |
111 |
$3K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$929.48 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$807.00 |
| D1330 |
|
28 |
28 |
$281.63 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$260.00 |