| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
546 |
536 |
$12K |
| D1110 |
Prophylaxis - adult |
291 |
285 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
45 |
$6K |
| D1120 |
Prophylaxis - child |
240 |
236 |
$6K |
| D1206 |
Topical application of fluoride varnish |
358 |
349 |
$5K |
| D0274 |
Bitewings - four radiographic images |
160 |
159 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
52 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
69 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$843.98 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$436.22 |