| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,309 |
10,874 |
$459K |
| D1206 |
Topical application of fluoride varnish |
11,281 |
10,848 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
9,497 |
9,158 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,934 |
2,254 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,413 |
2,543 |
$139K |
| D1351 |
Sealant - per tooth |
2,540 |
1,376 |
$139K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,731 |
1,613 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,170 |
949 |
$63K |
| D0274 |
Bitewings - four radiographic images |
3,710 |
3,536 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,596 |
2,438 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,719 |
4,481 |
$26K |
| D0272 |
Bitewings - two radiographic images |
2,380 |
2,284 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,374 |
1,286 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,132 |
3,361 |
$22K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
122 |
110 |
$13K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
106 |
97 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
348 |
319 |
$5K |
| D0330 |
Panoramic radiographic image |
298 |
263 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
40 |
$3K |
| D0270 |
|
190 |
182 |
$1K |
| D1110 |
Prophylaxis - adult |
34 |
23 |
$779.00 |
| D1999 |
|
1,174 |
1,056 |
$0.00 |