| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,757 |
2,592 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,098 |
666 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,247 |
3,041 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,211 |
1,129 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,977 |
1,856 |
$33K |
| D1120 |
Prophylaxis - child |
1,303 |
1,211 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
915 |
848 |
$27K |
| D2140 |
|
471 |
281 |
$24K |
| D1351 |
Sealant - per tooth |
695 |
100 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
218 |
202 |
$13K |
| D0272 |
Bitewings - two radiographic images |
549 |
501 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
25 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
407 |
362 |
$4K |
| D2160 |
|
44 |
33 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
133 |
115 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
84 |
$3K |
| D1206 |
Topical application of fluoride varnish |
81 |
75 |
$2K |