| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,384 |
831 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
6,649 |
6,551 |
$158K |
| D1120 |
Prophylaxis - child |
2,195 |
2,144 |
$70K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
836 |
434 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
983 |
519 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
861 |
579 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,661 |
2,603 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
719 |
509 |
$51K |
| D9248 |
|
574 |
551 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,276 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,003 |
966 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
523 |
514 |
$24K |
| D2929 |
|
181 |
56 |
$21K |
| D1110 |
Prophylaxis - adult |
458 |
453 |
$20K |
| D1510 |
|
82 |
58 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
912 |
873 |
$11K |
| D0272 |
Bitewings - two radiographic images |
560 |
554 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
384 |
$9K |
| D0274 |
Bitewings - four radiographic images |
310 |
310 |
$8K |
| D1351 |
Sealant - per tooth |
249 |
104 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
758 |
316 |
$7K |
| D0330 |
Panoramic radiographic image |
131 |
128 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
121 |
$3K |