| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
9,344 |
6,560 |
$602K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,656 |
7,140 |
$416K |
| D1120 |
Prophylaxis - child |
7,890 |
7,598 |
$311K |
| D0120 |
Periodic oral evaluation - established patient |
7,618 |
7,337 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,839 |
7,549 |
$195K |
| D1351 |
Sealant - per tooth |
2,657 |
1,433 |
$162K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
551 |
209 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,756 |
6,125 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
7,292 |
6,858 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
549 |
448 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
380 |
325 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,401 |
1,344 |
$24K |
| D0330 |
Panoramic radiographic image |
1,114 |
1,051 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
870 |
803 |
$19K |
| D0274 |
Bitewings - four radiographic images |
898 |
876 |
$15K |
| D1510 |
|
102 |
96 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
105 |
$5K |
| D1354 |
|
153 |
74 |
$5K |
| D0272 |
Bitewings - two radiographic images |
406 |
379 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
69 |
59 |
$3K |
| D9310 |
|
21 |
17 |
$239.40 |