| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,730 |
3,670 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,612 |
3,551 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,870 |
2,820 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,180 |
2,146 |
$48K |
| D1110 |
Prophylaxis - adult |
915 |
901 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,476 |
1,454 |
$40K |
| D9248 |
|
195 |
173 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
448 |
442 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
149 |
71 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
444 |
425 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
95 |
$16K |
| D1351 |
Sealant - per tooth |
543 |
143 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
321 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
550 |
470 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
40 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
142 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D1999 |
|
183 |
163 |
$0.00 |