| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,954 |
8,909 |
$494K |
| D1120 |
Prophylaxis - child |
8,498 |
8,460 |
$320K |
| D1351 |
Sealant - per tooth |
7,874 |
3,067 |
$212K |
| D0230 |
Intraoral - periapical each additional radiographic image |
44,745 |
10,419 |
$181K |
| D0274 |
Bitewings - four radiographic images |
8,278 |
8,248 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,588 |
1,704 |
$173K |
| D1110 |
Prophylaxis - adult |
1,893 |
1,879 |
$168K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,821 |
1,692 |
$159K |
| D1206 |
Topical application of fluoride varnish |
10,254 |
10,209 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,573 |
1,569 |
$103K |
| D2140 |
|
1,275 |
966 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,042 |
2,035 |
$24K |
| D2330 |
|
291 |
186 |
$22K |
| D2160 |
|
276 |
221 |
$22K |
| D4341 |
|
207 |
57 |
$14K |
| D2335 |
|
35 |
24 |
$4K |