| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
6,526 |
6,505 |
$195K |
| D1120 |
Prophylaxis - child |
4,385 |
4,373 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,817 |
6,796 |
$125K |
| D1110 |
Prophylaxis - adult |
2,436 |
2,428 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
8,773 |
8,668 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,678 |
7,966 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,134 |
619 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,322 |
2,310 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
3,986 |
3,977 |
$80K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
652 |
326 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
610 |
598 |
$35K |
| D1351 |
Sealant - per tooth |
1,312 |
335 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
285 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
534 |
$16K |
| D2140 |
|
194 |
119 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
72 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
40 |
$4K |
| D0272 |
Bitewings - two radiographic images |
111 |
110 |
$2K |
| D2160 |
|
21 |
12 |
$2K |
| D0270 |
|
14 |
14 |
$132.87 |