| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,955 |
3,776 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,842 |
1,826 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
599 |
386 |
$66K |
| D1206 |
Topical application of fluoride varnish |
2,575 |
2,548 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
3,382 |
1,844 |
$41K |
| D0330 |
Panoramic radiographic image |
944 |
883 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,192 |
1,741 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
957 |
933 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,054 |
970 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,128 |
1,209 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
112 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
173 |
115 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
178 |
178 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
125 |
$5K |
| D1351 |
Sealant - per tooth |
125 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
231 |
228 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
54 |
54 |
$2K |
| D0603 |
|
2,203 |
1,406 |
$0.00 |