| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,044 |
2,860 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,680 |
3,481 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,888 |
3,666 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,791 |
1,613 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
716 |
611 |
$41K |
| D1110 |
Prophylaxis - adult |
639 |
621 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
93 |
$6K |
| D1351 |
Sealant - per tooth |
241 |
78 |
$4K |
| D0272 |
Bitewings - two radiographic images |
179 |
177 |
$4K |
| D0330 |
Panoramic radiographic image |
72 |
61 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
23 |
14 |
$121.24 |