| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,331 |
1,291 |
$377.70 |
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,485 |
$227.52 |
| D0272 |
Bitewings - two radiographic images |
844 |
820 |
$142.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
51 |
$120.25 |
| D0274 |
Bitewings - four radiographic images |
350 |
349 |
$0.00 |
| D1110 |
Prophylaxis - adult |
103 |
102 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
174 |
174 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,461 |
1,406 |
$0.00 |
| D0240 |
|
34 |
13 |
$0.00 |