| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
7,449 |
1,543 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,418 |
656 |
$136K |
| D0145 |
Oral evaluation for a patient under three years of age |
814 |
785 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,478 |
3,438 |
$98K |
| D1120 |
Prophylaxis - child |
2,387 |
2,360 |
$85K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,275 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,002 |
3,442 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,960 |
3,893 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,763 |
3,711 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,049 |
1,038 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,402 |
1,383 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
403 |
248 |
$29K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
205 |
81 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
846 |
795 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
189 |
184 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
215 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$303.74 |
| D0603 |
|
5,094 |
5,018 |
$27.19 |
| D0602 |
|
14 |
14 |
$0.00 |