| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
151 |
151 |
$7K |
| D0274 |
Bitewings - four radiographic images |
149 |
149 |
$6K |
| D1206 |
Topical application of fluoride varnish |
187 |
187 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
116 |
116 |
$5K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
70 |
69 |
$2K |
| D1110 |
Prophylaxis - adult |
16 |
16 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
23 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$112.80 |