| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,044 |
1,996 |
$72K |
| D0145 |
Oral evaluation for a patient under three years of age |
517 |
512 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,400 |
2,342 |
$66K |
| D1110 |
Prophylaxis - adult |
916 |
904 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,896 |
2,825 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
234 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,219 |
2,566 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,887 |
2,812 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,268 |
1,237 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
774 |
$27K |
| D0274 |
Bitewings - four radiographic images |
781 |
771 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
301 |
290 |
$19K |
| D1351 |
Sealant - per tooth |
467 |
90 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
27 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
69 |
$1K |
| D0601 |
|
601 |
596 |
$0.03 |
| D0603 |
|
3,121 |
3,050 |
$0.02 |
| D1999 |
|
16 |
13 |
$0.00 |