| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,333 |
6,996 |
$296K |
| D1206 |
Topical application of fluoride varnish |
7,286 |
6,963 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,247 |
5,958 |
$172K |
| D1351 |
Sealant - per tooth |
2,769 |
1,382 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,112 |
1,514 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,119 |
1,017 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
737 |
502 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,833 |
1,733 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,253 |
1,188 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
536 |
406 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,475 |
2,352 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,326 |
1,268 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,746 |
1,443 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
414 |
390 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
78 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
295 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
85 |
84 |
$2K |
| D1110 |
Prophylaxis - adult |
49 |
49 |
$1K |
| D0270 |
|
65 |
59 |
$364.00 |
| D1999 |
|
370 |
294 |
$0.00 |