| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
555 |
310 |
$92K |
| D1351 |
Sealant - per tooth |
1,149 |
528 |
$92K |
| D1120 |
Prophylaxis - child |
1,260 |
1,259 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
279 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
385 |
276 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,640 |
1,637 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,189 |
1,188 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,092 |
1,089 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
440 |
324 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
1,100 |
$28K |
| D1110 |
Prophylaxis - adult |
502 |
501 |
$24K |
| D0274 |
Bitewings - four radiographic images |
828 |
827 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
109 |
91 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,652 |
1,640 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,431 |
1,410 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
115 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
272 |
270 |
$5K |
| D0272 |
Bitewings - two radiographic images |
251 |
250 |
$3K |
| D1999 |
|
155 |
143 |
$0.00 |