| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,859 |
7,512 |
$356K |
| D0120 |
Periodic oral evaluation - established patient |
10,152 |
8,526 |
$276K |
| D1351 |
Sealant - per tooth |
4,457 |
1,658 |
$254K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,842 |
7,497 |
$224K |
| D0274 |
Bitewings - four radiographic images |
6,700 |
5,558 |
$108K |
| D4341 |
|
559 |
227 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,526 |
918 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,433 |
2,861 |
$71K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
954 |
631 |
$66K |
| D1110 |
Prophylaxis - adult |
1,054 |
891 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
5,751 |
4,710 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,836 |
3,695 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,964 |
1,658 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,017 |
889 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
596 |
540 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
94 |
70 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
41 |
$3K |
| D4342 |
|
31 |
12 |
$3K |
| D2160 |
|
15 |
14 |
$839.90 |
| D1999 |
|
3,181 |
2,965 |
$0.00 |