| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,781 |
3,767 |
$188K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
770 |
437 |
$52K |
| D1351 |
Sealant - per tooth |
983 |
170 |
$32K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
440 |
256 |
$22K |
| D9222 |
|
28 |
27 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,516 |
1,505 |
$12K |
| D1120 |
Prophylaxis - child |
2,838 |
2,828 |
$11K |
| D1110 |
Prophylaxis - adult |
918 |
910 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
138 |
$10K |
| D2140 |
|
140 |
97 |
$9K |
| D1206 |
Topical application of fluoride varnish |
1,647 |
1,639 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
3,602 |
3,575 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,385 |
3,355 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
239 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,456 |
1,453 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,970 |
1,964 |
$279.02 |
| D0601 |
|
251 |
248 |
$0.00 |
| D0603 |
|
143 |
143 |
$0.00 |
| D0602 |
|
152 |
152 |
$0.00 |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
49 |
$0.00 |