| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,201 |
529 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,582 |
1,547 |
$44K |
| D1120 |
Prophylaxis - child |
1,157 |
1,134 |
$41K |
| D1110 |
Prophylaxis - adult |
764 |
754 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,908 |
1,875 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
88 |
$17K |
| D0145 |
Oral evaluation for a patient under three years of age |
88 |
87 |
$12K |
| D0274 |
Bitewings - four radiographic images |
456 |
444 |
$12K |
| D0330 |
Panoramic radiographic image |
284 |
273 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
122 |
$4K |
| D0272 |
Bitewings - two radiographic images |
185 |
180 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$943.23 |
| D0603 |
|
2,632 |
2,436 |
$0.00 |