| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
268 |
152 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
851 |
706 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
66 |
$11K |
| D1110 |
Prophylaxis - adult |
274 |
266 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
516 |
513 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
184 |
$3K |
| D2394 |
|
23 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$1K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$604.80 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$434.70 |