| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
1,672 |
788 |
$258K |
| D1120 |
Prophylaxis - child |
5,591 |
5,385 |
$228K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,920 |
1,987 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
6,209 |
5,986 |
$172K |
| D1351 |
Sealant - per tooth |
2,337 |
1,331 |
$131K |
| D1206 |
Topical application of fluoride varnish |
3,679 |
3,540 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,151 |
1,513 |
$93K |
| D0274 |
Bitewings - four radiographic images |
4,029 |
3,862 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,134 |
2,038 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,856 |
1,787 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
5,316 |
5,066 |
$32K |
| D1110 |
Prophylaxis - adult |
758 |
748 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,936 |
4,659 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
838 |
814 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
109 |
$10K |
| D0272 |
Bitewings - two radiographic images |
734 |
711 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
230 |
225 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
89 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
15 |
$1K |