| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,773 |
1,769 |
$50K |
| D1351 |
Sealant - per tooth |
1,568 |
400 |
$45K |
| D1120 |
Prophylaxis - child |
906 |
903 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,425 |
1,421 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
720 |
597 |
$32K |
| D1110 |
Prophylaxis - adult |
682 |
681 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
326 |
224 |
$21K |
| D0274 |
Bitewings - four radiographic images |
335 |
335 |
$13K |
| D1330 |
|
973 |
971 |
$10K |
| D1310 |
|
935 |
935 |
$10K |
| D0272 |
Bitewings - two radiographic images |
308 |
306 |
$8K |
| D0330 |
Panoramic radiographic image |
106 |
106 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
38 |
$3K |
| D0602 |
|
16 |
16 |
$80.00 |
| D1999 |
|
53 |
50 |
$0.00 |