| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,550 |
1,538 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
776 |
429 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,519 |
1,507 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,437 |
1,384 |
$39K |
| D2740 |
Crown - porcelain/ceramic |
130 |
85 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,619 |
1,568 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
818 |
791 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,071 |
1,056 |
$18K |
| D1110 |
Prophylaxis - adult |
304 |
301 |
$13K |
| D0330 |
Panoramic radiographic image |
512 |
507 |
$11K |
| D0274 |
Bitewings - four radiographic images |
610 |
605 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
103 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
14 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
851 |
829 |
$5K |
| D2950 |
|
65 |
52 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$486.05 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$432.51 |