| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,999 |
5,858 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
7,426 |
7,226 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,697 |
1,482 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,679 |
3,548 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,747 |
1,225 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,339 |
1,253 |
$81K |
| D1110 |
Prophylaxis - adult |
1,568 |
1,494 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,537 |
2,446 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,898 |
2,767 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,777 |
1,774 |
$47K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
783 |
492 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
834 |
779 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
5,326 |
5,148 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
284 |
267 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,464 |
1,431 |
$26K |
| D4341 |
|
132 |
69 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,232 |
3,827 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,681 |
1,647 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
550 |
545 |
$14K |
| D1351 |
Sealant - per tooth |
111 |
84 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
32 |
25 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
40 |
$3K |
| D2160 |
|
48 |
32 |
$3K |
| D2140 |
|
79 |
66 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$1K |
| D1999 |
|
108 |
102 |
$0.00 |