| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
172 |
65 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
62 |
60 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
96 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
127 |
$4K |
| D1120 |
Prophylaxis - child |
116 |
116 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
118 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
186 |
$3K |
| D1351 |
Sealant - per tooth |
96 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
113 |
38 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
33 |
31 |
$894.35 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
39 |
$477.28 |
| D0603 |
|
304 |
298 |
$0.00 |