| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,502 |
2,492 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
1,496 |
1,496 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,729 |
1,714 |
$113K |
| D1351 |
Sealant - per tooth |
2,551 |
585 |
$96K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,368 |
721 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,863 |
2,384 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
833 |
831 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,533 |
2,524 |
$36K |
| D2160 |
|
446 |
297 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,623 |
1,616 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
271 |
119 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
70 |
64 |
$32K |
| D2140 |
|
588 |
346 |
$32K |
| D0330 |
Panoramic radiographic image |
316 |
316 |
$9K |
| D1320 |
|
1,083 |
1,083 |
$8K |
| D0272 |
Bitewings - two radiographic images |
464 |
462 |
$6K |
| D0350 |
|
513 |
244 |
$5K |
| D9430 |
|
140 |
135 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
37 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
46 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
237 |
233 |
$3K |
| D2332 |
|
19 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
29 |
$1K |