| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,285 |
8,014 |
$333K |
| D0120 |
Periodic oral evaluation - established patient |
8,432 |
8,126 |
$232K |
| D8670 |
Periodic orthodontic treatment visit |
890 |
880 |
$212K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,913 |
5,710 |
$152K |
| D1351 |
Sealant - per tooth |
1,853 |
982 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,862 |
1,444 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,361 |
3,195 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,121 |
927 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,398 |
1,326 |
$29K |
| D1110 |
Prophylaxis - adult |
804 |
742 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,637 |
4,420 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,937 |
3,592 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
974 |
908 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
244 |
$13K |
| D0330 |
Panoramic radiographic image |
713 |
663 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
687 |
660 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,084 |
1,055 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
153 |
115 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
63 |
41 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$4K |
| D9110 |
|
67 |
65 |
$4K |
| D1206 |
Topical application of fluoride varnish |
21 |
20 |
$520.00 |