| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,780 |
8,579 |
$353K |
| D0120 |
Periodic oral evaluation - established patient |
9,667 |
9,344 |
$264K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,541 |
8,343 |
$218K |
| D1351 |
Sealant - per tooth |
2,195 |
1,055 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,892 |
1,349 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,346 |
5,213 |
$123K |
| D0274 |
Bitewings - four radiographic images |
8,111 |
7,853 |
$122K |
| D1110 |
Prophylaxis - adult |
2,655 |
2,590 |
$113K |
| D4341 |
|
450 |
224 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
13,646 |
13,139 |
$81K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,141 |
768 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,263 |
982 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,020 |
11,827 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
979 |
748 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
417 |
314 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
117 |
100 |
$33K |
| D0330 |
Panoramic radiographic image |
1,229 |
1,201 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,619 |
1,553 |
$27K |
| D0601 |
|
280 |
280 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
256 |
180 |
$22K |
| D0603 |
|
147 |
147 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,653 |
1,597 |
$15K |
| D0602 |
|
126 |
125 |
$15K |
| D2140 |
|
381 |
280 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
681 |
655 |
$12K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
37 |
$10K |
| D2160 |
|
144 |
106 |
$10K |
| D4910 |
|
14 |
14 |
$938.00 |
| D2950 |
|
18 |
13 |
$928.80 |