| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,527 |
13,939 |
$600K |
| D1351 |
Sealant - per tooth |
9,263 |
3,472 |
$474K |
| D0120 |
Periodic oral evaluation - established patient |
14,947 |
14,287 |
$418K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,480 |
13,897 |
$380K |
| D0274 |
Bitewings - four radiographic images |
2,363 |
2,242 |
$37K |
| D1110 |
Prophylaxis - adult |
1,275 |
1,209 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
939 |
619 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
5,989 |
5,648 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,628 |
5,084 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,530 |
1,473 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
525 |
405 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
397 |
310 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
899 |
850 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,476 |
1,426 |
$13K |
| D0601 |
|
4,847 |
4,771 |
$492.75 |
| D0602 |
|
2,874 |
2,851 |
$288.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$252.10 |
| D0603 |
|
660 |
644 |
$77.25 |