| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,401 |
10,005 |
$421K |
| D1351 |
Sealant - per tooth |
3,388 |
1,937 |
$260K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,581 |
9,212 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
8,605 |
8,286 |
$240K |
| D8670 |
Periodic orthodontic treatment visit |
705 |
675 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,806 |
1,302 |
$150K |
| D0274 |
Bitewings - four radiographic images |
4,693 |
4,503 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
9,942 |
9,525 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,244 |
8,828 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,871 |
1,794 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
267 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
438 |
366 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
473 |
358 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,145 |
1,101 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
114 |
75 |
$7K |
| D9110 |
|
117 |
115 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
14 |
$421.40 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$197.81 |