| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,345 |
3,333 |
$191K |
| D1110 |
Prophylaxis - adult |
1,853 |
1,846 |
$162K |
| D1120 |
Prophylaxis - child |
2,578 |
2,568 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,405 |
1,400 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,464 |
4,346 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,206 |
5,192 |
$68K |
| D0272 |
Bitewings - two radiographic images |
3,548 |
3,534 |
$42K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
330 |
181 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
415 |
$20K |
| D1351 |
Sealant - per tooth |
752 |
224 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
24 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
171 |
105 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
33 |
$4K |
| D0350 |
|
105 |
91 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
103 |
102 |
$1K |