| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,093 |
3,015 |
$423K |
| D1120 |
Prophylaxis - child |
8,966 |
8,577 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
10,023 |
9,613 |
$277K |
| D1206 |
Topical application of fluoride varnish |
6,081 |
5,813 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,291 |
1,723 |
$138K |
| D1110 |
Prophylaxis - adult |
3,113 |
3,000 |
$110K |
| D0274 |
Bitewings - four radiographic images |
6,137 |
5,870 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,803 |
1,325 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,088 |
2,950 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
11,007 |
10,449 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,415 |
2,307 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,303 |
8,480 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
2,367 |
2,292 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
574 |
429 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,087 |
1,997 |
$20K |
| D2330 |
|
21 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$928.80 |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
68 |
$838.30 |