| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,953 |
1,817 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,163 |
2,062 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,446 |
2,299 |
$35K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
211 |
77 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,128 |
1,057 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
137 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
96 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,378 |
527 |
$13K |
| D1110 |
Prophylaxis - adult |
350 |
340 |
$12K |
| D0274 |
Bitewings - four radiographic images |
448 |
426 |
$12K |
| D0330 |
Panoramic radiographic image |
354 |
316 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
280 |
255 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
763 |
701 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
84 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
361 |
338 |
$7K |
| D1351 |
Sealant - per tooth |
325 |
63 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
111 |
$3K |