| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,452 |
2,324 |
$84K |
| D0330 |
Panoramic radiographic image |
1,678 |
1,604 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,060 |
621 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,380 |
1,314 |
$70K |
| D1351 |
Sealant - per tooth |
2,821 |
343 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,278 |
3,082 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,942 |
1,842 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,805 |
1,730 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,843 |
1,746 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,779 |
1,675 |
$35K |
| D1120 |
Prophylaxis - child |
1,022 |
977 |
$29K |
| D4346 |
|
272 |
255 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
291 |
166 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,147 |
991 |
$11K |
| D4355 |
|
138 |
132 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
561 |
541 |
$9K |
| D9110 |
|
169 |
163 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
28 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
27 |
$3K |
| D2954 |
|
20 |
14 |
$3K |
| D0170 |
|
26 |
26 |
$620.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
43 |
$477.53 |