| Code | Description | Total Paid |
|---|
| D4341 |
|
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
$31K |
| D1120 |
Prophylaxis - child |
$26K |
| D1351 |
Sealant - per tooth |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
$17K |
| D1110 |
Prophylaxis - adult |
$17K |
| D0274 |
Bitewings - four radiographic images |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
$15K |