| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,438 |
2,710 |
$335K |
| D1120 |
Prophylaxis - child |
6,271 |
5,960 |
$253K |
| D0120 |
Periodic oral evaluation - established patient |
6,681 |
6,371 |
$184K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,794 |
5,528 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,267 |
1,637 |
$132K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,884 |
1,795 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,486 |
1,652 |
$116K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
815 |
684 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,337 |
4,183 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,822 |
7,659 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
734 |
588 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
9,579 |
9,156 |
$58K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
812 |
676 |
$57K |
| D0274 |
Bitewings - four radiographic images |
3,336 |
3,162 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
2,504 |
2,397 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
964 |
924 |
$25K |
| D2332 |
|
213 |
184 |
$22K |
| D1351 |
Sealant - per tooth |
316 |
125 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,581 |
1,488 |
$15K |
| D4341 |
|
76 |
36 |
$11K |
| D1110 |
Prophylaxis - adult |
228 |
218 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
50 |
$7K |
| D4342 |
|
50 |
28 |
$6K |
| D1354 |
|
160 |
72 |
$4K |
| D2750 |
|
14 |
14 |
$4K |
| D2335 |
|
15 |
12 |
$2K |
| D9110 |
|
12 |
12 |
$660.00 |
| D0330 |
Panoramic radiographic image |
16 |
14 |
$248.60 |