| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,429 |
1,679 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,217 |
892 |
$41K |
| D1110 |
Prophylaxis - adult |
849 |
826 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,539 |
1,366 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
926 |
894 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
96 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
194 |
193 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
299 |
280 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
545 |
507 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
383 |
362 |
$6K |
| D4355 |
|
61 |
61 |
$4K |
| D9110 |
|
68 |
37 |
$3K |
| D2335 |
|
15 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
50 |
43 |
$1K |
| D0274 |
Bitewings - four radiographic images |
30 |
29 |
$939.40 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$845.65 |
| D0272 |
Bitewings - two radiographic images |
23 |
14 |
$270.90 |