| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,194 |
6,882 |
$166K |
| D1206 |
Topical application of fluoride varnish |
9,023 |
8,611 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
6,952 |
6,635 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,124 |
5,703 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,737 |
5,085 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,868 |
3,641 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,665 |
1,565 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
855 |
361 |
$33K |
| D1110 |
Prophylaxis - adult |
1,424 |
1,354 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,774 |
1,648 |
$26K |
| D1354 |
|
2,077 |
494 |
$26K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
359 |
98 |
$25K |
| D0350 |
|
1,919 |
1,714 |
$24K |
| D1351 |
Sealant - per tooth |
1,774 |
431 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,291 |
1,163 |
$15K |
| D0330 |
Panoramic radiographic image |
981 |
916 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
116 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
196 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
45 |
$2K |
| D1330 |
|
6,343 |
5,910 |
$0.00 |
| D9920 |
|
16 |
15 |
$0.00 |
| D1999 |
|
1,526 |
1,434 |
$0.00 |