| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,659 |
1,584 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,354 |
717 |
$201K |
| D1351 |
Sealant - per tooth |
5,837 |
1,149 |
$133K |
| D1120 |
Prophylaxis - child |
2,481 |
2,319 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,739 |
2,585 |
$71K |
| D1110 |
Prophylaxis - adult |
1,211 |
1,146 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
812 |
745 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,420 |
3,215 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,303 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,785 |
2,543 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,929 |
2,747 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,048 |
925 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,023 |
962 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
65 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$237.24 |
| D0601 |
|
4,502 |
4,264 |
$0.11 |
| D0603 |
|
367 |
352 |
$0.00 |
| D0602 |
|
150 |
140 |
$0.00 |