| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,582 |
4,455 |
$82K |
| D1120 |
Prophylaxis - child |
2,850 |
2,753 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,531 |
2,450 |
$52K |
| D1110 |
Prophylaxis - adult |
1,433 |
1,363 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,626 |
1,448 |
$32K |
| D1999 |
|
4,108 |
3,739 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,321 |
1,273 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,210 |
1,176 |
$16K |
| D0330 |
Panoramic radiographic image |
126 |
123 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
110 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
81 |
$859.65 |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$856.80 |
| D2140 |
|
15 |
12 |
$528.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$395.85 |