| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
1,881 |
313 |
$47K |
| D1110 |
Prophylaxis - adult |
874 |
873 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,199 |
1,189 |
$29K |
| D0274 |
Bitewings - four radiographic images |
874 |
872 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
283 |
165 |
$17K |
| D1120 |
Prophylaxis - child |
552 |
542 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
787 |
777 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
514 |
513 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
189 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,009 |
1,003 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
934 |
833 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
52 |
$5K |
| D0272 |
Bitewings - two radiographic images |
306 |
300 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$1K |
| D1999 |
|
537 |
491 |
$0.00 |