| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,556 |
3,147 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
3,745 |
3,331 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,343 |
2,957 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,055 |
803 |
$74K |
| D1351 |
Sealant - per tooth |
957 |
591 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,102 |
989 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
840 |
758 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
310 |
$16K |
| D1110 |
Prophylaxis - adult |
553 |
509 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,716 |
2,392 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
185 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,371 |
2,078 |
$10K |
| D0272 |
Bitewings - two radiographic images |
999 |
866 |
$9K |
| D9110 |
|
196 |
170 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
103 |
76 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
322 |
291 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
159 |
128 |
$4K |
| D4341 |
|
20 |
12 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
204 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
17 |
$2K |
| D2332 |
|
12 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$657.91 |
| D1999 |
|
17 |
14 |
$0.00 |
| D1330 |
|
89 |
70 |
$0.00 |