| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
754 |
695 |
$29K |
| D1206 |
Topical application of fluoride varnish |
746 |
688 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
572 |
531 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
193 |
164 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
202 |
184 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
69 |
$3K |
| D0274 |
Bitewings - four radiographic images |
176 |
157 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
511 |
466 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
444 |
387 |
$2K |
| D0272 |
Bitewings - two radiographic images |
200 |
193 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
16 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$226.80 |
| D9310 |
|
17 |
13 |
$222.30 |