| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,158 |
5,867 |
$249K |
| D4341 |
|
1,285 |
645 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
6,078 |
5,802 |
$166K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,120 |
5,834 |
$157K |
| D1351 |
Sealant - per tooth |
2,192 |
1,026 |
$117K |
| D0274 |
Bitewings - four radiographic images |
4,150 |
3,981 |
$70K |
| D9110 |
|
1,076 |
1,049 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,604 |
2,500 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
631 |
442 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
8,710 |
8,273 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,443 |
7,053 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
355 |
273 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
101 |
78 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
119 |
$5K |
| D0272 |
Bitewings - two radiographic images |
303 |
284 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
63 |
$1K |
| D1110 |
Prophylaxis - adult |
19 |
14 |
$591.80 |
| D0270 |
|
46 |
45 |
$257.60 |