| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,114 |
1,005 |
$152K |
| D1120 |
Prophylaxis - child |
3,407 |
3,194 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
3,564 |
3,337 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,167 |
2,960 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,160 |
2,036 |
$31K |
| D4341 |
|
203 |
101 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,279 |
1,201 |
$28K |
| D0330 |
Panoramic radiographic image |
1,268 |
1,211 |
$25K |
| D1110 |
Prophylaxis - adult |
490 |
476 |
$21K |
| D1354 |
|
552 |
387 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
446 |
402 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
674 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
707 |
586 |
$3K |
| D0272 |
Bitewings - two radiographic images |
238 |
198 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
29 |
$690.48 |
| D2140 |
|
16 |
13 |
$678.70 |