| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,581 |
14,810 |
$668K |
| D0120 |
Periodic oral evaluation - established patient |
19,092 |
16,975 |
$526K |
| D1351 |
Sealant - per tooth |
10,152 |
3,735 |
$498K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,272 |
13,659 |
$390K |
| D4341 |
|
1,875 |
859 |
$276K |
| D0274 |
Bitewings - four radiographic images |
9,501 |
8,492 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,480 |
1,589 |
$155K |
| D1110 |
Prophylaxis - adult |
3,259 |
2,917 |
$139K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,985 |
1,146 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,774 |
1,217 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,737 |
3,354 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
11,724 |
10,339 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,386 |
963 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,853 |
8,800 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
2,060 |
1,800 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
441 |
373 |
$34K |
| D1206 |
Topical application of fluoride varnish |
983 |
882 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,574 |
2,275 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
202 |
155 |
$17K |
| D2160 |
|
133 |
90 |
$12K |
| D2140 |
|
135 |
93 |
$6K |
| D4342 |
|
86 |
33 |
$5K |
| D2335 |
|
23 |
13 |
$2K |
| D1999 |
|
4,689 |
4,351 |
$0.00 |