| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,083 |
1,083 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,465 |
1,465 |
$41K |
| D4341 |
|
239 |
116 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
441 |
353 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
949 |
948 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
464 |
381 |
$20K |
| D0274 |
Bitewings - four radiographic images |
857 |
854 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
437 |
$11K |
| D1351 |
Sealant - per tooth |
103 |
76 |
$10K |
| D1110 |
Prophylaxis - adult |
254 |
253 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
261 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
679 |
664 |
$5K |
| D0330 |
Panoramic radiographic image |
199 |
195 |
$4K |
| D4910 |
|
48 |
48 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
534 |
531 |
$2K |
| D1206 |
Topical application of fluoride varnish |
123 |
123 |
$2K |
| D0272 |
Bitewings - two radiographic images |
134 |
134 |
$1K |