| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
898 |
792 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,045 |
917 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
619 |
$14K |
| D9999 |
Unspecified adjunctive procedure, by report |
303 |
258 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
176 |
151 |
$5K |
| D0272 |
Bitewings - two radiographic images |
434 |
389 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
55 |
49 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
61 |
$1K |
| D0240 |
|
147 |
66 |
$1K |