| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,206 |
1,169 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,898 |
1,390 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,665 |
1,619 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
814 |
786 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,542 |
1,473 |
$18K |
| D0272 |
Bitewings - two radiographic images |
760 |
735 |
$17K |
| D1351 |
Sealant - per tooth |
609 |
72 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
244 |
237 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
59 |
$4K |
| D1110 |
Prophylaxis - adult |
54 |
52 |
$3K |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$298.10 |
| D0603 |
|
1,666 |
1,603 |
$0.54 |
| D0602 |
|
153 |
153 |
$0.00 |