| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,893 |
2,865 |
$79K |
| D1120 |
Prophylaxis - child |
2,142 |
2,123 |
$74K |
| D1110 |
Prophylaxis - adult |
1,332 |
1,318 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,444 |
3,412 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,566 |
1,542 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,305 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
941 |
840 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
170 |
168 |
$23K |
| D1351 |
Sealant - per tooth |
908 |
285 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
185 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
91 |
$12K |
| D0330 |
Panoramic radiographic image |
328 |
320 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
101 |
$3K |
| D0603 |
|
2,655 |
2,614 |
$0.00 |
| D0602 |
|
738 |
732 |
$0.00 |
| D0601 |
|
196 |
191 |
$0.00 |