| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,754 |
15,191 |
$641K |
| D1351 |
Sealant - per tooth |
10,092 |
4,479 |
$598K |
| D0120 |
Periodic oral evaluation - established patient |
16,569 |
15,936 |
$457K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,185 |
12,744 |
$343K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,162 |
1,706 |
$130K |
| D1110 |
Prophylaxis - adult |
2,719 |
2,607 |
$104K |
| D0274 |
Bitewings - four radiographic images |
5,681 |
5,388 |
$99K |
| D4341 |
|
562 |
296 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,962 |
3,787 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
11,495 |
10,911 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,350 |
9,801 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,499 |
1,421 |
$41K |
| D0272 |
Bitewings - two radiographic images |
3,869 |
3,745 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
515 |
442 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,293 |
1,258 |
$22K |
| D9110 |
|
239 |
235 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
132 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
13 |
$473.20 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$339.00 |
| D0270 |
|
15 |
15 |
$84.00 |
| D1999 |
|
19 |
19 |
$0.00 |