| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,318 |
3,116 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
3,173 |
2,984 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,263 |
3,065 |
$82K |
| D0274 |
Bitewings - four radiographic images |
740 |
690 |
$12K |
| D1351 |
Sealant - per tooth |
122 |
84 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
39 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
43 |
$392.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
24 |
$194.35 |
| D0272 |
Bitewings - two radiographic images |
16 |
13 |
$150.40 |
| D1999 |
|
399 |
330 |
$0.00 |