| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
1,562 |
1,549 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,997 |
630 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
4,773 |
4,710 |
$134K |
| D1120 |
Prophylaxis - child |
3,733 |
3,691 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,777 |
5,398 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,120 |
5,057 |
$73K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
499 |
119 |
$72K |
| D1110 |
Prophylaxis - adult |
1,329 |
1,310 |
$69K |
| D0272 |
Bitewings - two radiographic images |
3,037 |
3,003 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,598 |
5,481 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,538 |
1,514 |
$48K |
| D1351 |
Sealant - per tooth |
1,138 |
234 |
$29K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
135 |
41 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
36 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
297 |
270 |
$8K |
| D9248 |
|
42 |
40 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
133 |
$5K |
| D0330 |
Panoramic radiographic image |
179 |
174 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$859.64 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$501.75 |
| D0603 |
|
6,882 |
6,815 |
$0.00 |