| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,239 |
3,224 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,304 |
669 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,783 |
4,757 |
$101K |
| D1206 |
Topical application of fluoride varnish |
4,937 |
4,907 |
$83K |
| D0330 |
Panoramic radiographic image |
1,592 |
1,588 |
$78K |
| D1120 |
Prophylaxis - child |
2,139 |
2,129 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,011 |
1,999 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,112 |
1,108 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
518 |
321 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,380 |
1,360 |
$21K |
| D0272 |
Bitewings - two radiographic images |
780 |
780 |
$14K |
| D1351 |
Sealant - per tooth |
535 |
147 |
$13K |
| D0601 |
|
1,253 |
1,240 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,443 |
845 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
728 |
728 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
37 |
13 |
$5K |
| D1320 |
|
180 |
180 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
108 |
102 |
$3K |