| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,568 |
614 |
$185K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,361 |
1,290 |
$177K |
| D1120 |
Prophylaxis - child |
4,862 |
4,689 |
$162K |
| D1351 |
Sealant - per tooth |
6,379 |
1,128 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
5,493 |
5,297 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,086 |
5,599 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,118 |
747 |
$101K |
| D1206 |
Topical application of fluoride varnish |
6,213 |
5,989 |
$84K |
| D0220 |
Intraoral - periapical first radiographic image |
6,337 |
5,950 |
$70K |
| D1110 |
Prophylaxis - adult |
1,391 |
1,338 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,847 |
2,732 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,093 |
544 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,245 |
1,205 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,178 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,458 |
1,355 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
401 |
278 |
$29K |
| D0330 |
Panoramic radiographic image |
480 |
467 |
$25K |
| D9248 |
|
84 |
82 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
472 |
$8K |
| D1510 |
|
19 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
31 |
$2K |
| D1330 |
|
1,424 |
1,406 |
$208.25 |
| D0603 |
|
8,428 |
8,112 |
$0.00 |