| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,405 |
5,240 |
$215K |
| D1351 |
Sealant - per tooth |
3,495 |
1,929 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,328 |
5,159 |
$149K |
| D1206 |
Topical application of fluoride varnish |
5,375 |
5,212 |
$135K |
| D1354 |
|
1,014 |
578 |
$23K |
| D0601 |
|
2,172 |
2,114 |
$22K |
| D0602 |
|
1,721 |
1,686 |
$18K |
| D0603 |
|
1,176 |
1,146 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
729 |
720 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
98 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
57 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
35 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
225 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37 |
37 |
$232.97 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$199.40 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$144.17 |