| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,498 |
1,443 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,233 |
2,134 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
136 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,246 |
1,177 |
$19K |
| D1120 |
Prophylaxis - child |
552 |
503 |
$13K |
| D0274 |
Bitewings - four radiographic images |
392 |
358 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
68 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
209 |
196 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
96 |
$2K |
| D0272 |
Bitewings - two radiographic images |
84 |
69 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$531.28 |