| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,947 |
1,878 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
811 |
402 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
1,910 |
1,847 |
$4K |
| D1206 |
Topical application of fluoride varnish |
2,063 |
1,982 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
173 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,234 |
2,147 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,518 |
2,420 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,012 |
977 |
$2K |
| D0274 |
Bitewings - four radiographic images |
757 |
714 |
$2K |
| D1110 |
Prophylaxis - adult |
409 |
400 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
13 |
$1K |
| D1351 |
Sealant - per tooth |
358 |
97 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
31 |
$961.98 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
243 |
223 |
$886.43 |
| D0330 |
Panoramic radiographic image |
219 |
217 |
$779.41 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
345 |
293 |
$459.02 |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
47 |
$393.90 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
53 |
$266.39 |
| D1208 |
Topical application of fluoride, excluding varnish |
329 |
326 |
$264.76 |
| D0140 |
Limited oral evaluation - problem focused |
60 |
56 |
$164.22 |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
51 |
$30.13 |