| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,263 |
236 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
633 |
632 |
$16K |
| D1110 |
Prophylaxis - adult |
387 |
386 |
$14K |
| D1120 |
Prophylaxis - child |
411 |
411 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
592 |
592 |
$11K |
| D0274 |
Bitewings - four radiographic images |
384 |
381 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
58 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
222 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
599 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
577 |
541 |
$4K |
| D0272 |
Bitewings - two radiographic images |
205 |
205 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |
| D1999 |
|
251 |
242 |
$0.00 |