| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
312 |
297 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,246 |
1,168 |
$33K |
| D1110 |
Prophylaxis - adult |
648 |
609 |
$31K |
| D1120 |
Prophylaxis - child |
687 |
652 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,479 |
1,399 |
$20K |
| D0274 |
Bitewings - four radiographic images |
747 |
681 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,206 |
1,453 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,674 |
1,518 |
$17K |
| D1351 |
Sealant - per tooth |
273 |
55 |
$7K |
| D0272 |
Bitewings - two radiographic images |
246 |
239 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
115 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
202 |
183 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D0601 |
|
560 |
534 |
$0.00 |
| D0603 |
|
648 |
626 |
$0.00 |
| D0602 |
|
433 |
425 |
$0.00 |