| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
12,220 |
11,740 |
$503K |
| D1351 |
Sealant - per tooth |
5,146 |
3,245 |
$406K |
| D0120 |
Periodic oral evaluation - established patient |
11,734 |
11,250 |
$330K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,068 |
11,606 |
$315K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,504 |
10,772 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
11,774 |
11,214 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,907 |
3,729 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
853 |
814 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,487 |
1,404 |
$15K |
| D4341 |
|
88 |
38 |
$14K |
| D1110 |
Prophylaxis - adult |
315 |
294 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
222 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
399 |
367 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
131 |
99 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
158 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
74 |
$6K |
| D0330 |
Panoramic radiographic image |
195 |
182 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
225 |
$4K |
| D2140 |
|
26 |
25 |
$1K |