| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,942 |
4,511 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
7,081 |
6,395 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,982 |
1,730 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,686 |
4,264 |
$118K |
| D0274 |
Bitewings - four radiographic images |
5,322 |
4,733 |
$88K |
| D4342 |
|
795 |
388 |
$85K |
| D4341 |
|
534 |
273 |
$83K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
985 |
571 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,623 |
2,338 |
$56K |
| D1110 |
Prophylaxis - adult |
1,405 |
1,238 |
$55K |
| D1351 |
Sealant - per tooth |
675 |
270 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,802 |
4,196 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
5,348 |
4,759 |
$31K |
| D2140 |
|
604 |
371 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
724 |
670 |
$9K |
| D0272 |
Bitewings - two radiographic images |
668 |
596 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
48 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
135 |
$3K |
| D2160 |
|
37 |
29 |
$2K |
| D1999 |
|
2,220 |
2,045 |
$0.00 |