| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,573 |
552 |
$444K |
| D2934 |
|
703 |
241 |
$120K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,046 |
362 |
$90K |
| D7240 |
Removal of impacted tooth - completely bony |
263 |
81 |
$72K |
| D9420 |
|
300 |
288 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
239 |
102 |
$24K |
| D0350 |
|
483 |
273 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
409 |
$17K |
| D1206 |
Topical application of fluoride varnish |
966 |
910 |
$17K |
| D1120 |
Prophylaxis - child |
507 |
483 |
$16K |
| D0272 |
Bitewings - two radiographic images |
522 |
501 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
610 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
441 |
409 |
$7K |
| D1110 |
Prophylaxis - adult |
123 |
106 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
170 |
153 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
180 |
157 |
$4K |
| D0330 |
Panoramic radiographic image |
47 |
37 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
78 |
78 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
16 |
$2K |
| D0274 |
Bitewings - four radiographic images |
57 |
46 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
42 |
$1K |