| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,700 |
3,488 |
$90K |
| D1110 |
Prophylaxis - adult |
1,685 |
1,616 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,400 |
3,223 |
$53K |
| D1120 |
Prophylaxis - child |
1,815 |
1,703 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
415 |
247 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,294 |
2,166 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
635 |
530 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,891 |
1,737 |
$22K |
| D0274 |
Bitewings - four radiographic images |
530 |
496 |
$15K |
| D0272 |
Bitewings - two radiographic images |
168 |
161 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
41 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$1K |
| D1999 |
|
509 |
438 |
$0.00 |