| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
14,634 |
14,587 |
$592K |
| D0120 |
Periodic oral evaluation - established patient |
9,934 |
9,911 |
$581K |
| D1310 |
|
6,285 |
6,272 |
$286K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,456 |
4,447 |
$285K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,255 |
926 |
$267K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,386 |
15,331 |
$252K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,707 |
1,790 |
$248K |
| D1351 |
Sealant - per tooth |
7,744 |
2,350 |
$228K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,590 |
1,871 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,273 |
1,762 |
$187K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,796 |
740 |
$178K |
| D9993 |
|
2,898 |
2,896 |
$177K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43,825 |
13,393 |
$175K |
| D2140 |
|
2,914 |
1,391 |
$158K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,470 |
2,458 |
$156K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,788 |
3,558 |
$150K |
| D1110 |
Prophylaxis - adult |
1,711 |
1,707 |
$145K |
| D9430 |
|
3,411 |
2,979 |
$109K |
| D0272 |
Bitewings - two radiographic images |
7,841 |
7,817 |
$91K |
| D0350 |
|
8,705 |
3,838 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,296 |
725 |
$87K |
| D0603 |
|
4,332 |
4,320 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,778 |
2,774 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,788 |
4,566 |
$57K |
| D2330 |
|
701 |
406 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
409 |
407 |
$18K |
| D0602 |
|
1,185 |
1,185 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
67 |
$13K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
21 |
12 |
$12K |
| D2160 |
|
138 |
81 |
$11K |
| D0601 |
|
521 |
520 |
$8K |
| D9920 |
|
14 |
14 |
$2K |
| D2331 |
|
21 |
12 |
$2K |
| D9222 |
|
12 |
12 |
$1K |