| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,621 |
3,824 |
$123K |
| D2140 |
|
2,464 |
994 |
$66K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,692 |
834 |
$54K |
| D0272 |
Bitewings - two radiographic images |
3,549 |
2,912 |
$51K |
| D1999 |
|
3,375 |
2,891 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,205 |
2,667 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,971 |
1,599 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,253 |
1,039 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
359 |
203 |
$11K |
| D2160 |
|
312 |
175 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,390 |
872 |
$8K |
| D1120 |
Prophylaxis - child |
383 |
321 |
$7K |
| D2335 |
|
124 |
55 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
606 |
$5K |
| D1351 |
Sealant - per tooth |
228 |
29 |
$3K |
| D2330 |
|
61 |
30 |
$2K |
| D2331 |
|
35 |
12 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$448.70 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$377.62 |