| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
937 |
778 |
$34K |
| D1110 |
Prophylaxis - adult |
696 |
690 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,122 |
1,107 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
121 |
$24K |
| D0272 |
Bitewings - two radiographic images |
936 |
913 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
703 |
687 |
$13K |
| D1120 |
Prophylaxis - child |
281 |
278 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
395 |
$6K |
| D1206 |
Topical application of fluoride varnish |
52 |
51 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$720.52 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$180.00 |