| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
4,342 |
482 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,416 |
1,297 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
312 |
$29K |
| D1120 |
Prophylaxis - child |
1,027 |
947 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
544 |
277 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,311 |
1,164 |
$20K |
| D1110 |
Prophylaxis - adult |
724 |
649 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,679 |
2,360 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,366 |
1,214 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,298 |
2,098 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
958 |
855 |
$13K |
| D0272 |
Bitewings - two radiographic images |
495 |
474 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
354 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
19 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
259 |
219 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
45 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
24 |
$2K |
| D1999 |
|
398 |
264 |
$0.00 |