| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,187 |
1,163 |
$33K |
| D1120 |
Prophylaxis - child |
920 |
901 |
$32K |
| D1351 |
Sealant - per tooth |
1,174 |
201 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,315 |
1,286 |
$19K |
| D0272 |
Bitewings - two radiographic images |
791 |
774 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,283 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,291 |
1,219 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$11K |
| D1110 |
Prophylaxis - adult |
102 |
101 |
$5K |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$671.08 |
| D0603 |
|
1,628 |
1,597 |
$0.00 |