| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,538 |
3,406 |
$686.86 |
| D0120 |
Periodic oral evaluation - established patient |
3,508 |
3,381 |
$455.25 |
| D1206 |
Topical application of fluoride varnish |
4,185 |
4,033 |
$404.04 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,756 |
3,652 |
$236.15 |
| D0220 |
Intraoral - periapical first radiographic image |
3,949 |
3,788 |
$202.30 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
434 |
419 |
$189.96 |
| D0272 |
Bitewings - two radiographic images |
2,491 |
2,405 |
$79.05 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
590 |
514 |
$58.00 |
| D1110 |
Prophylaxis - adult |
357 |
347 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
393 |
387 |
$0.00 |
| D0330 |
Panoramic radiographic image |
86 |
81 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,114 |
343 |
$0.00 |
| D1330 |
|
3,114 |
2,913 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
65 |
65 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
150 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$0.00 |