| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
237 |
225 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
272 |
260 |
$7K |
| D1206 |
Topical application of fluoride varnish |
235 |
230 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
221 |
213 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
114 |
$2K |
| D1351 |
Sealant - per tooth |
52 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
35 |
35 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
28 |
$747.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$366.96 |