| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
15,608 |
15,238 |
$641K |
| D1206 |
Topical application of fluoride varnish |
14,666 |
14,317 |
$382K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,678 |
4,107 |
$381K |
| D0120 |
Periodic oral evaluation - established patient |
13,042 |
12,739 |
$366K |
| D1351 |
Sealant - per tooth |
5,664 |
3,259 |
$332K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,641 |
2,751 |
$149K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,619 |
1,561 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,781 |
1,387 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,884 |
3,722 |
$87K |
| D0274 |
Bitewings - four radiographic images |
5,102 |
4,913 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
781 |
686 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
6,865 |
6,555 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
2,218 |
2,119 |
$38K |
| D0272 |
Bitewings - two radiographic images |
3,339 |
3,247 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,625 |
4,785 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
771 |
752 |
$19K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
116 |
110 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
560 |
542 |
$11K |
| D1110 |
Prophylaxis - adult |
310 |
290 |
$10K |
| D0330 |
Panoramic radiographic image |
295 |
284 |
$6K |
| D0270 |
|
806 |
766 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
37 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
45 |
44 |
$3K |
| D2330 |
|
16 |
12 |
$887.06 |
| D2140 |
|
25 |
12 |
$771.25 |
| D9310 |
|
28 |
27 |
$393.30 |
| D1999 |
|
764 |
613 |
$0.00 |