| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,899 |
2,725 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,029 |
2,831 |
$46K |
| D1206 |
Topical application of fluoride varnish |
3,394 |
3,171 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
960 |
890 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
576 |
308 |
$44K |
| D1351 |
Sealant - per tooth |
2,150 |
484 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,850 |
1,692 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,444 |
1,347 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
978 |
$20K |
| D1120 |
Prophylaxis - child |
725 |
671 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
276 |
98 |
$9K |
| D0272 |
Bitewings - two radiographic images |
595 |
539 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
554 |
506 |
$4K |
| D2394 |
|
41 |
29 |
$3K |
| D4355 |
|
33 |
31 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D0170 |
|
120 |
83 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
12 |
$1K |