| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,742 |
1,742 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
1,866 |
1,866 |
$40K |
| D0274 |
Bitewings - four radiographic images |
719 |
719 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
508 |
479 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
621 |
621 |
$9K |
| D1206 |
Topical application of fluoride varnish |
337 |
337 |
$6K |
| D1120 |
Prophylaxis - child |
138 |
138 |
$4K |
| D0330 |
Panoramic radiographic image |
79 |
79 |
$4K |
| D0350 |
|
58 |
58 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$887.53 |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
40 |
$568.64 |