| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,142 |
2,141 |
$90K |
| D1351 |
Sealant - per tooth |
1,038 |
717 |
$82K |
| D1206 |
Topical application of fluoride varnish |
2,081 |
2,080 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,874 |
1,874 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,698 |
1,697 |
$48K |
| D0272 |
Bitewings - two radiographic images |
2,677 |
2,676 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,956 |
2,954 |
$19K |
| D0330 |
Panoramic radiographic image |
563 |
563 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,781 |
2,772 |
$12K |
| D1354 |
|
297 |
248 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
250 |
$5K |
| D0274 |
Bitewings - four radiographic images |
247 |
247 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
63 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
239 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
38 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
25 |
$2K |