| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
579 |
574 |
$24K |
| D0330 |
Panoramic radiographic image |
463 |
451 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
976 |
947 |
$19K |
| D1120 |
Prophylaxis - child |
500 |
492 |
$14K |
| D0274 |
Bitewings - four radiographic images |
431 |
421 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
851 |
825 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
786 |
688 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
371 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
229 |
190 |
$6K |
| D3120 |
|
92 |
63 |
$3K |
| D0272 |
Bitewings - two radiographic images |
134 |
134 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
70 |
$2K |
| D1351 |
Sealant - per tooth |
66 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
65 |
$691.59 |