| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,008 |
963 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,314 |
1,220 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
883 |
845 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
131 |
24 |
$13K |
| D0272 |
Bitewings - two radiographic images |
619 |
593 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
129 |
$5K |
| D0240 |
|
350 |
175 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
82 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
81 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
110 |
$992.72 |