| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,278 |
2,232 |
$142K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,945 |
999 |
$125K |
| D2160 |
|
1,408 |
708 |
$108K |
| D1110 |
Prophylaxis - adult |
1,308 |
1,279 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,039 |
1,993 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,906 |
1,874 |
$87K |
| D1120 |
Prophylaxis - child |
2,306 |
2,257 |
$82K |
| D1351 |
Sealant - per tooth |
2,499 |
633 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
532 |
271 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,975 |
2,677 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,757 |
3,676 |
$46K |
| D9430 |
|
908 |
864 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,154 |
1,125 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
862 |
846 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
13 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
102 |
41 |
$6K |
| D0272 |
Bitewings - two radiographic images |
502 |
486 |
$5K |
| D4341 |
|
55 |
15 |
$4K |
| D2161 |
|
17 |
12 |
$1K |