| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,242 |
3,141 |
$113K |
| D1110 |
Prophylaxis - adult |
1,959 |
1,887 |
$107K |
| D1206 |
Topical application of fluoride varnish |
4,434 |
4,255 |
$86K |
| D1120 |
Prophylaxis - child |
1,822 |
1,750 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,295 |
1,198 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
362 |
162 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,312 |
2,241 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
482 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
451 |
$20K |
| D4341 |
|
170 |
132 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
250 |
$13K |
| D0272 |
Bitewings - two radiographic images |
659 |
624 |
$11K |
| D4346 |
|
168 |
167 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
115 |
87 |
$6K |
| D1351 |
Sealant - per tooth |
229 |
95 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
412 |
362 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
515 |
162 |
$4K |
| D0330 |
Panoramic radiographic image |
58 |
50 |
$1K |
| D4910 |
|
23 |
23 |
$1K |
| D9995 |
|
44 |
41 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
63 |
$942.00 |
| D0240 |
|
52 |
25 |
$436.80 |
| D0603 |
|
1,005 |
983 |
$434.70 |
| D0601 |
|
80 |
80 |
$5.00 |
| D0602 |
|
30 |
30 |
$2.00 |
| D1330 |
|
2,765 |
2,530 |
$0.00 |
| D1310 |
|
2,231 |
2,055 |
$0.00 |