| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,903 |
1,777 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,972 |
822 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
1,977 |
1,828 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,954 |
3,515 |
$19K |
| D1120 |
Prophylaxis - child |
1,274 |
1,197 |
$12K |
| D0274 |
Bitewings - four radiographic images |
2,079 |
1,920 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,345 |
651 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,309 |
2,370 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
664 |
240 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,561 |
1,388 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
122 |
71 |
$7K |
| D1110 |
Prophylaxis - adult |
1,312 |
1,206 |
$6K |
| D1206 |
Topical application of fluoride varnish |
666 |
639 |
$5K |
| D2140 |
|
46 |
26 |
$3K |
| D2950 |
|
451 |
237 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
309 |
106 |
$3K |
| D9420 |
|
489 |
432 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
294 |
153 |
$1K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
45 |
24 |
$944.83 |
| D0330 |
Panoramic radiographic image |
284 |
264 |
$748.55 |
| D0272 |
Bitewings - two radiographic images |
529 |
478 |
$559.44 |
| D2390 |
|
37 |
12 |
$390.30 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,155 |
1,038 |
$302.09 |
| D9243 |
|
969 |
361 |
$150.66 |
| D0210 |
Intraoral - complete series of radiographic images |
103 |
92 |
$73.74 |
| D9239 |
|
441 |
351 |
$50.22 |
| D0350 |
|
78 |
67 |
$0.00 |
| D9219 |
|
90 |
71 |
$0.00 |
| D4341 |
|
258 |
59 |
$0.00 |
| D2332 |
|
24 |
12 |
$0.00 |
| D9248 |
|
16 |
14 |
$0.00 |
| D0603 |
|
29 |
29 |
$0.00 |
| D9920 |
|
104 |
83 |
$0.00 |