| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
13,849 |
12,602 |
$550K |
| D1351 |
Sealant - per tooth |
8,568 |
3,293 |
$506K |
| D0120 |
Periodic oral evaluation - established patient |
13,880 |
12,560 |
$375K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,423 |
12,266 |
$337K |
| D0274 |
Bitewings - four radiographic images |
7,884 |
7,101 |
$133K |
| D1110 |
Prophylaxis - adult |
2,885 |
2,659 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,204 |
4,694 |
$108K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,468 |
896 |
$75K |
| D4341 |
|
443 |
258 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
812 |
597 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
6,376 |
5,710 |
$36K |
| D0272 |
Bitewings - two radiographic images |
3,643 |
3,291 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,310 |
4,122 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,307 |
1,198 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
247 |
106 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
238 |
$12K |
| D1206 |
Topical application of fluoride varnish |
307 |
225 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
125 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
13 |
$1K |
| D1999 |
|
2,588 |
2,486 |
$0.00 |