| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
12,621 |
2,245 |
$314K |
| D1120 |
Prophylaxis - child |
4,751 |
4,564 |
$144K |
| D1110 |
Prophylaxis - adult |
3,343 |
3,217 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,904 |
5,660 |
$131K |
| D1206 |
Topical application of fluoride varnish |
6,568 |
6,322 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
538 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,651 |
2,534 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
836 |
410 |
$65K |
| D0272 |
Bitewings - two radiographic images |
2,675 |
2,549 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,989 |
1,932 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
635 |
305 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
617 |
597 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
941 |
816 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
53 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
943 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
389 |
$12K |
| D1999 |
|
1,032 |
1,021 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
464 |
455 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$140.00 |