| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
3,196 |
3,178 |
$448K |
| D1120 |
Prophylaxis - child |
9,909 |
9,856 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
12,423 |
12,353 |
$355K |
| D1110 |
Prophylaxis - adult |
4,486 |
4,457 |
$243K |
| D1206 |
Topical application of fluoride varnish |
14,858 |
14,772 |
$216K |
| D0272 |
Bitewings - two radiographic images |
8,674 |
8,632 |
$194K |
| D0220 |
Intraoral - periapical first radiographic image |
16,008 |
15,896 |
$189K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,116 |
15,175 |
$187K |
| D0274 |
Bitewings - four radiographic images |
5,230 |
5,199 |
$165K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
788 |
256 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,098 |
670 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,149 |
2,134 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
685 |
405 |
$64K |
| D9248 |
|
375 |
359 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
958 |
935 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
46 |
12 |
$13K |
| D0330 |
Panoramic radiographic image |
897 |
887 |
$11K |
| D1351 |
Sealant - per tooth |
227 |
54 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
154 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
101 |
101 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$918.32 |
| D7111 |
|
22 |
16 |
$252.34 |
| D0603 |
|
19,657 |
19,511 |
$0.00 |
| D9986 |
|
204 |
197 |
$0.00 |
| D9987 |
|
15 |
14 |
$0.00 |