| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,371 |
3,357 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
2,457 |
2,449 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,430 |
3,412 |
$65K |
| D0272 |
Bitewings - two radiographic images |
1,175 |
1,167 |
$21K |
| D0603 |
|
2,671 |
2,660 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,460 |
418 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
740 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
244 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
259 |
253 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
51 |
14 |
$6K |
| D0240 |
|
355 |
209 |
$6K |
| D1351 |
Sealant - per tooth |
126 |
40 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
115 |
115 |
$3K |
| D1354 |
|
690 |
250 |
$2K |
| D1999 |
|
257 |
255 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$996.48 |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$986.00 |
| D0602 |
|
101 |
98 |
$660.00 |
| D0330 |
Panoramic radiographic image |
35 |
34 |
$312.00 |
| D0601 |
|
25 |
24 |
$176.00 |
| D1330 |
|
2,027 |
2,012 |
$0.06 |
| D1310 |
|
1,370 |
1,369 |
$0.03 |