| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,224 |
1,194 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,344 |
1,301 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,248 |
1,216 |
$40K |
| D2140 |
|
417 |
314 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
184 |
150 |
$13K |
| D0274 |
Bitewings - four radiographic images |
402 |
398 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
119 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
126 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
34 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
213 |
208 |
$2K |
| D1351 |
Sealant - per tooth |
41 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
65 |
62 |
$627.38 |