| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,729 |
1,664 |
$93K |
| D1120 |
Prophylaxis - child |
2,025 |
1,959 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,746 |
745 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,818 |
2,698 |
$80K |
| D1351 |
Sealant - per tooth |
3,770 |
614 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,464 |
638 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,132 |
2,052 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,418 |
2,322 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,470 |
1,423 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
766 |
407 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,210 |
2,109 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
585 |
234 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
651 |
617 |
$20K |
| D0330 |
Panoramic radiographic image |
562 |
536 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,824 |
2,585 |
$16K |
| D0240 |
|
585 |
571 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
69 |
$6K |
| D1110 |
Prophylaxis - adult |
251 |
239 |
$5K |
| D1353 |
|
241 |
48 |
$4K |
| D0601 |
|
513 |
495 |
$2K |
| D2950 |
|
36 |
24 |
$2K |
| D0603 |
|
345 |
340 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
45 |
45 |
$1K |
| D0272 |
Bitewings - two radiographic images |
67 |
65 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
41 |
$811.36 |
| D9999 |
Unspecified adjunctive procedure, by report |
28 |
28 |
$560.00 |
| D0602 |
|
84 |
80 |
$392.00 |