| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
3,632 |
3,452 |
$778K |
| D1120 |
Prophylaxis - child |
10,507 |
9,994 |
$420K |
| D1351 |
Sealant - per tooth |
5,390 |
2,521 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
10,405 |
9,909 |
$283K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,330 |
8,866 |
$235K |
| D4341 |
|
1,276 |
604 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,778 |
1,910 |
$173K |
| D0274 |
Bitewings - four radiographic images |
8,487 |
7,996 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,473 |
4,246 |
$96K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,042 |
790 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,736 |
10,562 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
12,958 |
12,149 |
$74K |
| D1110 |
Prophylaxis - adult |
1,941 |
1,840 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,219 |
906 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,646 |
2,484 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
697 |
546 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
467 |
390 |
$32K |
| D8680 |
|
216 |
197 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,680 |
1,590 |
$16K |
| D2950 |
|
241 |
209 |
$14K |
| D9110 |
|
198 |
189 |
$8K |
| D8999 |
|
254 |
246 |
$8K |
| D4342 |
|
46 |
28 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
416 |
369 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$3K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
116 |
115 |
$3K |
| D2331 |
|
23 |
13 |
$2K |
| D1354 |
|
53 |
36 |
$1K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$823.82 |
| D0270 |
|
44 |
43 |
$240.80 |