| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,435 |
1,431 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,586 |
1,583 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
386 |
259 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,518 |
1,513 |
$32K |
| D0272 |
Bitewings - two radiographic images |
920 |
917 |
$26K |
| D0274 |
Bitewings - four radiographic images |
535 |
534 |
$22K |
| D0330 |
Panoramic radiographic image |
224 |
223 |
$16K |
| D1110 |
Prophylaxis - adult |
281 |
281 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
195 |
142 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
68 |
$10K |
| D1351 |
Sealant - per tooth |
123 |
26 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
76 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
16 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
156 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
117 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$164.92 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
30 |
$0.00 |