| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,237 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
309 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
438 |
$43K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
312 |
165 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,467 |
1,390 |
$10K |
| D1351 |
Sealant - per tooth |
555 |
147 |
$7K |
| D2140 |
|
39 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
993 |
978 |
$973.63 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,644 |
1,026 |
$728.29 |
| D1110 |
Prophylaxis - adult |
501 |
488 |
$468.81 |
| D1120 |
Prophylaxis - child |
851 |
839 |
$287.08 |
| D0274 |
Bitewings - four radiographic images |
766 |
753 |
$278.55 |
| D0272 |
Bitewings - two radiographic images |
284 |
277 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$0.00 |