| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,532 |
2,523 |
$161K |
| D1120 |
Prophylaxis - child |
3,389 |
3,377 |
$140K |
| D1206 |
Topical application of fluoride varnish |
3,243 |
3,232 |
$53K |
| D1310 |
|
846 |
842 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
566 |
566 |
$36K |
| D1351 |
Sealant - per tooth |
1,020 |
265 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,899 |
1,896 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
307 |
168 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,886 |
2,471 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
440 |
409 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
194 |
192 |
$13K |
| D0603 |
|
480 |
479 |
$6K |
| D0330 |
Panoramic radiographic image |
151 |
147 |
$4K |
| D0274 |
Bitewings - four radiographic images |
191 |
189 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
23 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
130 |
$2K |
| D0602 |
|
69 |
65 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$922.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
80 |
$787.00 |