| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
3,092 |
665 |
$80K |
| D1120 |
Prophylaxis - child |
1,771 |
1,742 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
422 |
418 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,004 |
1,973 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
560 |
295 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,423 |
2,391 |
$35K |
| D1110 |
Prophylaxis - adult |
547 |
544 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,278 |
2,213 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,342 |
2,073 |
$24K |
| D0350 |
|
1,585 |
1,552 |
$23K |
| D0272 |
Bitewings - two radiographic images |
984 |
967 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
219 |
138 |
$17K |
| D0274 |
Bitewings - four radiographic images |
477 |
471 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
214 |
213 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
207 |
$7K |
| D0240 |
|
479 |
479 |
$5K |
| D1330 |
|
552 |
539 |
$822.00 |
| D0602 |
|
2,771 |
2,745 |
$36.20 |
| D0603 |
|
121 |
120 |
$0.01 |
| D0601 |
|
13 |
13 |
$0.00 |