| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,523 |
2,012 |
$448K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,957 |
1,926 |
$269K |
| D1120 |
Prophylaxis - child |
4,977 |
4,933 |
$178K |
| D1351 |
Sealant - per tooth |
6,519 |
1,805 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
5,781 |
5,752 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,010 |
6,908 |
$134K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
925 |
467 |
$129K |
| D0272 |
Bitewings - two radiographic images |
4,562 |
4,517 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,940 |
6,880 |
$100K |
| D1110 |
Prophylaxis - adult |
1,856 |
1,845 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,067 |
6,982 |
$86K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
837 |
428 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,959 |
1,946 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,197 |
2,051 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,242 |
1,214 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
290 |
180 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
78 |
$25K |
| D9248 |
|
69 |
66 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
46 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$761.53 |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$332.08 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$225.36 |
| D0603 |
|
9,181 |
9,063 |
$0.00 |