| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,617 |
8,291 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
10,426 |
9,999 |
$285K |
| D1351 |
Sealant - per tooth |
4,164 |
1,771 |
$275K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,403 |
7,106 |
$192K |
| D4341 |
|
567 |
290 |
$98K |
| D9110 |
|
1,488 |
1,447 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
12,305 |
11,686 |
$74K |
| D1110 |
Prophylaxis - adult |
1,559 |
1,480 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
802 |
592 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,069 |
10,469 |
$46K |
| D0272 |
Bitewings - two radiographic images |
4,652 |
4,422 |
$44K |
| D2394 |
|
516 |
435 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,807 |
1,718 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,755 |
1,688 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
852 |
815 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
90 |
77 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
294 |
223 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
525 |
411 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
105 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
16 |
$4K |
| D4910 |
|
44 |
43 |
$3K |
| D2950 |
|
43 |
41 |
$3K |
| D0270 |
|
411 |
396 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$742.61 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$426.72 |