| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,978 |
16,911 |
$998K |
| D1120 |
Prophylaxis - child |
22,962 |
22,886 |
$956K |
| D1310 |
|
9,823 |
9,786 |
$441K |
| D1351 |
Sealant - per tooth |
12,690 |
3,596 |
$367K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,905 |
22,816 |
$360K |
| D0230 |
Intraoral - periapical each additional radiographic image |
73,750 |
18,954 |
$303K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,215 |
4,205 |
$276K |
| D9993 |
|
3,356 |
3,353 |
$203K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,655 |
1,167 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,112 |
2,051 |
$170K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,470 |
2,463 |
$163K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,690 |
1,165 |
$162K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,261 |
1,145 |
$147K |
| D0220 |
Intraoral - periapical first radiographic image |
10,602 |
10,421 |
$123K |
| D0603 |
|
7,488 |
7,452 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,685 |
1,159 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,069 |
2,001 |
$81K |
| D0272 |
Bitewings - two radiographic images |
6,085 |
6,076 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,205 |
834 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,752 |
2,741 |
$57K |
| D9430 |
|
1,108 |
1,057 |
$35K |
| D0602 |
|
2,068 |
2,068 |
$30K |
| D2140 |
|
416 |
269 |
$22K |
| D0350 |
|
887 |
479 |
$7K |
| D2160 |
|
56 |
49 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
15 |
$1K |
| D1354 |
|
104 |
33 |
$360.00 |