| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,838 |
3,767 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
1,836 |
1,808 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,851 |
1,127 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,667 |
3,611 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
494 |
368 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,921 |
3,722 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,406 |
920 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,021 |
1,993 |
$25K |
| D1120 |
Prophylaxis - child |
976 |
967 |
$11K |
| D0274 |
Bitewings - four radiographic images |
3,407 |
3,359 |
$11K |
| D1206 |
Topical application of fluoride varnish |
3,418 |
3,350 |
$8K |
| D1351 |
Sealant - per tooth |
1,466 |
290 |
$7K |
| D1330 |
|
4,832 |
4,746 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
412 |
401 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
4,061 |
3,972 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,348 |
1,334 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$1K |
| D4341 |
|
39 |
13 |
$713.60 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$355.39 |
| D2940 |
|
16 |
14 |
$146.22 |
| D0601 |
|
96 |
95 |
$95.00 |