| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,107 |
1,083 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,211 |
1,178 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
984 |
955 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,201 |
1,174 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,191 |
2,123 |
$17K |
| D1110 |
Prophylaxis - adult |
555 |
541 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
269 |
144 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,646 |
1,925 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
745 |
730 |
$10K |
| D1206 |
Topical application of fluoride varnish |
833 |
810 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
67 |
$6K |
| D1351 |
Sealant - per tooth |
356 |
79 |
$6K |
| D4355 |
|
90 |
89 |
$6K |
| D0272 |
Bitewings - two radiographic images |
360 |
346 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
68 |
39 |
$4K |
| D4341 |
|
31 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
84 |
$1K |