| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,809 |
9,913 |
$439K |
| D0120 |
Periodic oral evaluation - established patient |
13,046 |
12,020 |
$359K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,755 |
9,865 |
$277K |
| D1351 |
Sealant - per tooth |
3,074 |
925 |
$160K |
| D0274 |
Bitewings - four radiographic images |
7,143 |
6,581 |
$124K |
| D1110 |
Prophylaxis - adult |
2,460 |
2,284 |
$103K |
| D4341 |
|
657 |
299 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,735 |
3,370 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
8,658 |
7,941 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,816 |
6,921 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
574 |
341 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,094 |
1,904 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
879 |
817 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
140 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
514 |
$6K |
| D9110 |
|
113 |
94 |
$6K |
| D4342 |
|
32 |
16 |
$4K |
| D2160 |
|
74 |
54 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
40 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$1K |
| D2140 |
|
26 |
24 |
$894.65 |
| D1999 |
|
4,619 |
4,305 |
$0.00 |