| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,719 |
1,717 |
$81K |
| D1110 |
Prophylaxis - adult |
935 |
933 |
$60K |
| D1120 |
Prophylaxis - child |
967 |
966 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,552 |
1,550 |
$44K |
| D0274 |
Bitewings - four radiographic images |
725 |
723 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
400 |
370 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
134 |
$24K |
| D1351 |
Sealant - per tooth |
527 |
187 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
75 |
$12K |
| D0603 |
|
1,898 |
1,896 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
420 |
410 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
236 |
157 |
$4K |
| D1330 |
|
1,954 |
1,951 |
$3K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$2K |
| D1206 |
Topical application of fluoride varnish |
50 |
50 |
$2K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$2K |