| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,062 |
321 |
$281K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
348 |
113 |
$29K |
| D1120 |
Prophylaxis - child |
798 |
765 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,721 |
1,391 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,867 |
1,656 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
995 |
947 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
820 |
765 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,392 |
1,326 |
$22K |
| D0272 |
Bitewings - two radiographic images |
863 |
827 |
$18K |
| D1351 |
Sealant - per tooth |
506 |
100 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
472 |
440 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
54 |
51 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
103 |
44 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
33 |
$5K |
| D9248 |
|
47 |
43 |
$5K |
| D1110 |
Prophylaxis - adult |
73 |
73 |
$3K |
| D0603 |
|
1,457 |
1,373 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$986.72 |
| D0274 |
Bitewings - four radiographic images |
33 |
30 |
$889.53 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$757.15 |
| D9420 |
|
15 |
15 |
$36.31 |