| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
987 |
193 |
$100K |
| D1120 |
Prophylaxis - child |
2,143 |
2,065 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,140 |
1,097 |
$44K |
| D1206 |
Topical application of fluoride varnish |
2,648 |
2,562 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,467 |
1,424 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,431 |
1,386 |
$25K |
| D1351 |
Sealant - per tooth |
952 |
266 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,320 |
684 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
230 |
130 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,043 |
981 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
229 |
84 |
$11K |
| D0330 |
Panoramic radiographic image |
222 |
219 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
345 |
330 |
$9K |
| D0274 |
Bitewings - four radiographic images |
340 |
337 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
463 |
425 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
119 |
81 |
$7K |
| D1110 |
Prophylaxis - adult |
196 |
196 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
149 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
127 |
126 |
$3K |
| D1510 |
|
15 |
12 |
$2K |
| D0240 |
|
63 |
48 |
$895.00 |