| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,049 |
1,940 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,808 |
2,379 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
693 |
230 |
$36K |
| D1110 |
Prophylaxis - adult |
1,479 |
868 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,053 |
1,804 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,251 |
1,465 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,689 |
1,755 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,495 |
1,044 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,612 |
1,592 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
378 |
245 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
700 |
430 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
351 |
233 |
$10K |
| D1351 |
Sealant - per tooth |
666 |
141 |
$10K |
| D0330 |
Panoramic radiographic image |
212 |
181 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
55 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
14 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
39 |
$1K |
| D1354 |
|
47 |
13 |
$705.00 |
| D0140 |
Limited oral evaluation - problem focused |
39 |
37 |
$630.72 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$438.74 |
| D1999 |
|
768 |
457 |
$0.00 |
| D0603 |
|
476 |
458 |
$0.00 |
| D3120 |
|
56 |
29 |
$0.00 |