| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
787 |
699 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
823 |
721 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
763 |
679 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
210 |
$17K |
| D1351 |
Sealant - per tooth |
213 |
126 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
95 |
77 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
136 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
168 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
88 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
188 |
$4K |
| D0274 |
Bitewings - four radiographic images |
238 |
201 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
580 |
512 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
160 |
138 |
$2K |
| D1110 |
Prophylaxis - adult |
98 |
88 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
504 |
441 |
$2K |
| D0272 |
Bitewings - two radiographic images |
183 |
165 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
51 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$843.20 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$781.85 |