| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,042 |
1,042 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,202 |
1,202 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,069 |
1,069 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
304 |
301 |
$4K |
| D1110 |
Prophylaxis - adult |
85 |
85 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
216 |
136 |
$2K |
| D0274 |
Bitewings - four radiographic images |
51 |
51 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
33 |
$949.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$264.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
15 |
$0.00 |