| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1999 |
|
1,757 |
1,339 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,823 |
1,698 |
$24K |
| D1120 |
Prophylaxis - child |
859 |
808 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,144 |
1,087 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
139 |
$19K |
| D1110 |
Prophylaxis - adult |
278 |
254 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
85 |
$9K |
| D0272 |
Bitewings - two radiographic images |
271 |
252 |
$4K |
| D0330 |
Panoramic radiographic image |
79 |
73 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
93 |
$2K |
| D0274 |
Bitewings - four radiographic images |
92 |
79 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
28 |
$630.00 |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
54 |
$600.60 |