| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,482 |
1,141 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,328 |
2,480 |
$296K |
| D1354 |
|
6,031 |
3,406 |
$200K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,535 |
2,018 |
$179K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,404 |
1,110 |
$171K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,885 |
2,715 |
$169K |
| D1120 |
Prophylaxis - child |
4,266 |
4,201 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,248 |
5,127 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,044 |
896 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,256 |
6,709 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,207 |
4,151 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,168 |
3,120 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,716 |
1,335 |
$84K |
| D1351 |
Sealant - per tooth |
1,166 |
682 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
7,754 |
7,575 |
$49K |
| D4342 |
|
254 |
128 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,102 |
1,069 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,094 |
1,068 |
$18K |
| D2330 |
|
221 |
183 |
$17K |
| D4341 |
|
73 |
32 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
465 |
423 |
$11K |
| D0272 |
Bitewings - two radiographic images |
743 |
724 |
$7K |
| D2335 |
|
55 |
46 |
$7K |
| D9110 |
|
134 |
130 |
$7K |
| D2332 |
|
63 |
52 |
$6K |
| D1206 |
Topical application of fluoride varnish |
221 |
204 |
$5K |
| D1510 |
|
64 |
64 |
$5K |