| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
818 |
811 |
$115K |
| D1351 |
Sealant - per tooth |
3,353 |
765 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,058 |
3,027 |
$87K |
| D1120 |
Prophylaxis - child |
2,373 |
2,349 |
$86K |
| D0272 |
Bitewings - two radiographic images |
2,348 |
2,328 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
560 |
241 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,308 |
3,276 |
$48K |
| D1110 |
Prophylaxis - adult |
854 |
843 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,553 |
3,501 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,358 |
3,317 |
$38K |
| D0274 |
Bitewings - four radiographic images |
865 |
850 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
517 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
53 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$225.36 |
| D0602 |
|
3,667 |
3,640 |
$0.00 |
| D0601 |
|
130 |
130 |
$0.00 |