| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,713 |
10,507 |
$355K |
| D0120 |
Periodic oral evaluation - established patient |
12,906 |
12,719 |
$249K |
| D0274 |
Bitewings - four radiographic images |
9,077 |
8,879 |
$230K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,353 |
2,048 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,912 |
1,344 |
$159K |
| D8670 |
Periodic orthodontic treatment visit |
735 |
673 |
$133K |
| D1120 |
Prophylaxis - child |
3,827 |
3,809 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,033 |
1,178 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
11,885 |
11,561 |
$91K |
| D1351 |
Sealant - per tooth |
3,500 |
645 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,070 |
9,779 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,063 |
800 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,504 |
1,495 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,979 |
2,918 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,772 |
2,749 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,744 |
2,738 |
$50K |
| D5110 |
|
93 |
93 |
$44K |
| D2332 |
|
376 |
239 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
611 |
557 |
$23K |
| D1330 |
|
3,500 |
3,479 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,310 |
1,296 |
$21K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
47 |
34 |
$20K |
| D0330 |
Panoramic radiographic image |
476 |
476 |
$17K |
| D2331 |
|
315 |
208 |
$17K |
| D5120 |
|
31 |
31 |
$15K |
| D2330 |
|
318 |
178 |
$14K |
| D0601 |
|
1,678 |
1,670 |
$14K |
| D1310 |
|
2,006 |
1,987 |
$13K |
| D9110 |
|
412 |
410 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
360 |
345 |
$11K |
| D0603 |
|
1,374 |
1,363 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
93 |
59 |
$9K |
| D2335 |
|
141 |
85 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$7K |
| D5213 |
|
15 |
15 |
$7K |
| D4341 |
|
96 |
40 |
$6K |
| D5214 |
|
14 |
14 |
$6K |
| D8660 |
|
109 |
105 |
$5K |
| D2394 |
|
78 |
64 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$1K |