| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,073 |
2,073 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,356 |
2,356 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,745 |
1,745 |
$21K |
| D1206 |
Topical application of fluoride varnish |
662 |
662 |
$16K |
| D0272 |
Bitewings - two radiographic images |
996 |
996 |
$13K |
| D0274 |
Bitewings - four radiographic images |
635 |
635 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
991 |
989 |
$9K |
| D1110 |
Prophylaxis - adult |
188 |
188 |
$8K |
| D1351 |
Sealant - per tooth |
227 |
58 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
892 |
892 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$298.93 |