| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
11,364 |
5,004 |
$511K |
| D1120 |
Prophylaxis - child |
11,222 |
10,764 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
12,339 |
11,901 |
$330K |
| D1206 |
Topical application of fluoride varnish |
8,200 |
7,977 |
$177K |
| D4341 |
|
984 |
547 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,839 |
2,635 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,159 |
2,046 |
$47K |
| D0330 |
Panoramic radiographic image |
1,650 |
1,569 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,102 |
1,992 |
$31K |
| D1110 |
Prophylaxis - adult |
707 |
678 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
349 |
249 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
658 |
624 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
78 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
448 |
420 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
58 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
856 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
30 |
27 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
42 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
625 |
501 |
$3K |
| D4910 |
|
50 |
47 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
57 |
$3K |
| D0272 |
Bitewings - two radiographic images |
151 |
142 |
$1K |
| D9310 |
|
18 |
15 |
$205.20 |
| D0270 |
|
31 |
31 |
$173.60 |
| D0603 |
|
191 |
191 |
$0.00 |
| D0602 |
|
1,288 |
1,262 |
$0.00 |
| D0601 |
|
6,106 |
5,983 |
$0.00 |