| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,711 |
1,670 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
2,344 |
2,289 |
$85K |
| D1206 |
Topical application of fluoride varnish |
3,228 |
3,111 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
814 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,821 |
1,776 |
$38K |
| D1120 |
Prophylaxis - child |
801 |
760 |
$35K |
| D4341 |
|
313 |
256 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
454 |
440 |
$20K |
| D4346 |
|
195 |
193 |
$14K |
| D4342 |
|
185 |
145 |
$13K |
| D4910 |
|
257 |
246 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
147 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
40 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
503 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
149 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
385 |
96 |
$3K |
| D0272 |
Bitewings - two radiographic images |
93 |
90 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$869.86 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$778.54 |
| D0240 |
|
59 |
30 |
$450.00 |
| D0603 |
|
1,103 |
1,062 |
$261.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$157.20 |
| D0601 |
|
276 |
274 |
$40.00 |
| D0602 |
|
163 |
162 |
$12.00 |
| D1330 |
|
2,356 |
2,261 |
$1.40 |
| D1310 |
|
1,777 |
1,703 |
$0.00 |