| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
186 |
182 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
379 |
373 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
17 |
$9K |
| D1120 |
Prophylaxis - child |
237 |
233 |
$8K |
| D1110 |
Prophylaxis - adult |
130 |
130 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
584 |
433 |
$7K |
| D1206 |
Topical application of fluoride varnish |
407 |
400 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
470 |
462 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
31 |
$5K |
| D0272 |
Bitewings - two radiographic images |
199 |
195 |
$5K |
| D0274 |
Bitewings - four radiographic images |
130 |
130 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
18 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$975.43 |
| D0330 |
Panoramic radiographic image |
53 |
51 |
$878.15 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
32 |
$867.52 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
21 |
$393.96 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$205.80 |
| D0603 |
|
749 |
737 |
$0.15 |