| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,325 |
109 |
$13K |
| D1110 |
Prophylaxis - adult |
247 |
191 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
54 |
$3K |
| D0274 |
Bitewings - four radiographic images |
300 |
231 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
185 |
$3K |
| D1120 |
Prophylaxis - child |
246 |
173 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
292 |
218 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
507 |
374 |
$2K |
| D1206 |
Topical application of fluoride varnish |
301 |
219 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
534 |
347 |
$2K |
| D0272 |
Bitewings - two radiographic images |
109 |
81 |
$923.13 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$668.63 |
| D0330 |
Panoramic radiographic image |
58 |
47 |
$578.55 |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
15 |
$552.79 |
| D0140 |
Limited oral evaluation - problem focused |
32 |
25 |
$363.19 |
| D1999 |
|
255 |
210 |
$0.00 |