| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
332 |
288 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
153 |
$14K |
| D1351 |
Sealant - per tooth |
477 |
115 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
454 |
$13K |
| D1120 |
Prophylaxis - child |
236 |
236 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
323 |
322 |
$10K |
| D1110 |
Prophylaxis - adult |
158 |
158 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
95 |
$7K |
| D0274 |
Bitewings - four radiographic images |
88 |
88 |
$4K |
| D0272 |
Bitewings - two radiographic images |
104 |
103 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D1330 |
|
13 |
13 |
$0.00 |
| D1310 |
|
13 |
13 |
$0.00 |