| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,369 |
5,279 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,118 |
1,733 |
$140K |
| D1120 |
Prophylaxis - child |
3,344 |
3,304 |
$138K |
| D4341 |
|
700 |
379 |
$122K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,404 |
1,074 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,074 |
1,666 |
$98K |
| D1110 |
Prophylaxis - adult |
2,013 |
1,999 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,158 |
3,125 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,438 |
7,422 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
3,663 |
3,329 |
$68K |
| D0274 |
Bitewings - four radiographic images |
3,499 |
3,451 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
10,279 |
9,700 |
$65K |
| D2750 |
|
227 |
203 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
472 |
388 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,755 |
1,744 |
$43K |
| D1351 |
Sealant - per tooth |
566 |
265 |
$38K |
| D9110 |
|
661 |
633 |
$36K |
| D1354 |
|
1,318 |
628 |
$33K |
| D4342 |
|
118 |
77 |
$22K |
| D2335 |
|
135 |
105 |
$15K |
| D9630 |
|
587 |
543 |
$10K |
| D2394 |
|
98 |
91 |
$9K |
| D2332 |
|
36 |
30 |
$4K |
| D0330 |
Panoramic radiographic image |
185 |
177 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
57 |
$4K |
| D0272 |
Bitewings - two radiographic images |
194 |
191 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
90 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| D2950 |
|
12 |
12 |
$875.42 |