| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,773 |
7,434 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
9,601 |
9,236 |
$257K |
| D1351 |
Sealant - per tooth |
2,855 |
1,909 |
$238K |
| D1206 |
Topical application of fluoride varnish |
3,776 |
3,607 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,639 |
3,477 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,277 |
3,139 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
642 |
552 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,056 |
5,773 |
$36K |
| D1110 |
Prophylaxis - adult |
996 |
966 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,358 |
1,291 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,014 |
4,798 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,248 |
1,189 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
553 |
513 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,104 |
1,055 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$928.80 |