| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,077 |
1,027 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
928 |
886 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,330 |
1,265 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
991 |
496 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
71 |
67 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
590 |
$7K |
| D0272 |
Bitewings - two radiographic images |
200 |
199 |
$5K |
| D0274 |
Bitewings - four radiographic images |
172 |
156 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
101 |
$3K |
| D0240 |
|
259 |
120 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
92 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
30 |
$1K |
| D1351 |
Sealant - per tooth |
62 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$801.39 |
| D0603 |
|
1,708 |
1,646 |
$0.00 |