| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
761 |
725 |
$100K |
| D1120 |
Prophylaxis - child |
1,436 |
1,334 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,594 |
1,490 |
$42K |
| D1110 |
Prophylaxis - adult |
637 |
582 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,151 |
1,997 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,168 |
899 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
465 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
210 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,072 |
995 |
$12K |
| D0274 |
Bitewings - four radiographic images |
373 |
346 |
$11K |
| D0272 |
Bitewings - two radiographic images |
385 |
357 |
$8K |
| D1351 |
Sealant - per tooth |
80 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D0601 |
|
936 |
885 |
$0.00 |
| D0603 |
|
1,637 |
1,547 |
$0.00 |
| D0602 |
|
211 |
191 |
$0.00 |
| D1999 |
|
391 |
351 |
$0.00 |