| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,541 |
$31K |
| D1120 |
Prophylaxis - child |
992 |
992 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,684 |
1,681 |
$25K |
| D1110 |
Prophylaxis - adult |
486 |
486 |
$21K |
| D0274 |
Bitewings - four radiographic images |
671 |
671 |
$20K |
| D0330 |
Panoramic radiographic image |
355 |
355 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
535 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
61 |
12 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
250 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
357 |
357 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
295 |
295 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
17 |
$3K |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$731.16 |