| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,208 |
2,172 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,161 |
3,100 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,457 |
2,413 |
$50K |
| D1120 |
Prophylaxis - child |
939 |
922 |
$29K |
| D0272 |
Bitewings - two radiographic images |
805 |
790 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
108 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
170 |
$12K |
| D0330 |
Panoramic radiographic image |
192 |
189 |
$8K |
| D0274 |
Bitewings - four radiographic images |
31 |
31 |
$857.37 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$380.25 |
| D1999 |
|
29 |
27 |
$0.00 |