| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,715 |
1,694 |
$113K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
165 |
133 |
$79K |
| D1120 |
Prophylaxis - child |
1,368 |
1,354 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
951 |
565 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
683 |
683 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
886 |
457 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,030 |
1,020 |
$49K |
| D1351 |
Sealant - per tooth |
1,124 |
313 |
$42K |
| D1110 |
Prophylaxis - adult |
355 |
350 |
$31K |
| D9430 |
|
927 |
888 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,756 |
1,735 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
242 |
164 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,338 |
2,044 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
422 |
278 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,831 |
1,741 |
$22K |
| D0350 |
|
2,243 |
882 |
$21K |
| D1310 |
|
230 |
230 |
$11K |
| D0274 |
Bitewings - four radiographic images |
288 |
286 |
$6K |
| D4910 |
|
54 |
50 |
$4K |
| D4341 |
|
51 |
14 |
$4K |
| D2954 |
|
34 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
131 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0601 |
|
28 |
28 |
$420.00 |
| D0603 |
|
12 |
12 |
$180.00 |