| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,119 |
1,154 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
3,405 |
3,285 |
$88K |
| D1110 |
Prophylaxis - adult |
1,489 |
1,440 |
$69K |
| D1120 |
Prophylaxis - child |
1,865 |
1,798 |
$66K |
| D1206 |
Topical application of fluoride varnish |
3,209 |
3,107 |
$63K |
| D2160 |
|
645 |
389 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,383 |
2,307 |
$57K |
| D0240 |
|
2,371 |
2,295 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,746 |
1,534 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,584 |
2,486 |
$43K |
| D2140 |
|
582 |
394 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
407 |
391 |
$35K |
| D0603 |
|
2,007 |
1,937 |
$10K |
| D1351 |
Sealant - per tooth |
243 |
90 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
57 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$434.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
24 |
$344.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
25 |
$342.00 |
| D0601 |
|
16 |
14 |
$71.12 |
| D0602 |
|
14 |
14 |
$70.00 |