| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,159 |
2,042 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,854 |
2,671 |
$79K |
| D1206 |
Topical application of fluoride varnish |
931 |
893 |
$24K |
| D1110 |
Prophylaxis - adult |
357 |
355 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
361 |
288 |
$15K |
| D0274 |
Bitewings - four radiographic images |
566 |
559 |
$10K |
| D1351 |
Sealant - per tooth |
133 |
78 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
94 |
$6K |
| D9110 |
|
52 |
52 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
100 |
$2K |
| D0272 |
Bitewings - two radiographic images |
72 |
71 |
$754.33 |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
85 |
$543.76 |