| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
997 |
954 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
910 |
873 |
$28K |
| D1206 |
Topical application of fluoride varnish |
923 |
880 |
$26K |
| D1351 |
Sealant - per tooth |
789 |
192 |
$19K |
| D0272 |
Bitewings - two radiographic images |
472 |
454 |
$6K |
| D0603 |
|
895 |
852 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
715 |
682 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
682 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
129 |
129 |
$2K |
| D0274 |
Bitewings - four radiographic images |
114 |
102 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
59 |
58 |
$2K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$928.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$600.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$272.00 |