| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,582 |
1,511 |
$41K |
| D1120 |
Prophylaxis - child |
1,261 |
1,197 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,826 |
1,747 |
$24K |
| D1110 |
Prophylaxis - adult |
484 |
461 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,733 |
1,639 |
$19K |
| D0274 |
Bitewings - four radiographic images |
642 |
606 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,669 |
1,543 |
$17K |
| D0272 |
Bitewings - two radiographic images |
714 |
687 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
135 |
124 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
156 |
108 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
137 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
257 |
187 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
53 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
175 |
167 |
$5K |
| D1351 |
Sealant - per tooth |
122 |
28 |
$3K |
| D0603 |
|
1,788 |
1,712 |
$1.14 |
| D0602 |
|
371 |
359 |
$0.00 |
| D0601 |
|
19 |
17 |
$0.00 |