| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,990 |
5,963 |
$268K |
| D1206 |
Topical application of fluoride varnish |
6,688 |
6,660 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
5,770 |
5,745 |
$180K |
| D1110 |
Prophylaxis - adult |
868 |
864 |
$31K |
| D1351 |
Sealant - per tooth |
867 |
169 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
325 |
185 |
$31K |
| D0330 |
Panoramic radiographic image |
496 |
496 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,719 |
1,711 |
$21K |
| D0240 |
|
937 |
924 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,472 |
1,442 |
$20K |
| D0601 |
|
1,994 |
1,994 |
$20K |
| D0274 |
Bitewings - four radiographic images |
954 |
950 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,756 |
1,743 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
391 |
391 |
$13K |
| D0602 |
|
992 |
991 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$5K |
| D0350 |
|
564 |
562 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
143 |
143 |
$3K |
| D0603 |
|
273 |
273 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
16 |
$375.00 |