| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
2,671 |
1,043 |
$143K |
| D1120 |
Prophylaxis - child |
3,526 |
3,384 |
$143K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,858 |
1,211 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,299 |
3,167 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,504 |
3,360 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,383 |
3,228 |
$76K |
| D0274 |
Bitewings - four radiographic images |
3,865 |
3,714 |
$58K |
| D1110 |
Prophylaxis - adult |
1,223 |
1,188 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
644 |
476 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
841 |
595 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,082 |
789 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
5,915 |
5,603 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,279 |
5,229 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
861 |
797 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
310 |
188 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
469 |
452 |
$8K |
| D0272 |
Bitewings - two radiographic images |
583 |
553 |
$5K |
| D4341 |
|
27 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
87 |
83 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
14 |
$1K |
| D2140 |
|
32 |
29 |
$1K |
| D4910 |
|
14 |
14 |
$938.00 |
| D0603 |
|
12 |
12 |
$510.75 |
| D1999 |
|
44 |
42 |
$0.00 |