| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
20,756 |
20,004 |
$837K |
| D0120 |
Periodic oral evaluation - established patient |
21,162 |
20,401 |
$592K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,824 |
20,057 |
$530K |
| D1351 |
Sealant - per tooth |
5,190 |
3,158 |
$278K |
| D0274 |
Bitewings - four radiographic images |
6,691 |
6,423 |
$120K |
| D0220 |
Intraoral - periapical first radiographic image |
12,599 |
12,021 |
$74K |
| D1110 |
Prophylaxis - adult |
1,320 |
1,299 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,654 |
11,266 |
$56K |
| D0272 |
Bitewings - two radiographic images |
4,477 |
4,288 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,313 |
1,267 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
339 |
214 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
393 |
283 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
186 |
$12K |
| D4341 |
|
36 |
15 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
255 |
237 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
85 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D1999 |
|
669 |
574 |
$0.00 |