| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,550 |
1,539 |
$81K |
| D1120 |
Prophylaxis - child |
1,228 |
1,217 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,225 |
1,214 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,863 |
1,847 |
$21K |
| D1110 |
Prophylaxis - adult |
194 |
193 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,872 |
1,707 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
95 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
27 |
$5K |
| D1351 |
Sealant - per tooth |
95 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$180.00 |