| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,149 |
10,002 |
$419K |
| D1351 |
Sealant - per tooth |
4,701 |
2,004 |
$329K |
| D1206 |
Topical application of fluoride varnish |
9,700 |
9,553 |
$254K |
| D0120 |
Periodic oral evaluation - established patient |
8,557 |
8,432 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,494 |
1,255 |
$106K |
| D0274 |
Bitewings - four radiographic images |
2,660 |
2,616 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
754 |
713 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
474 |
398 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
6,138 |
5,999 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,626 |
1,589 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,948 |
5,496 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,016 |
1,976 |
$21K |
| D8670 |
Periodic orthodontic treatment visit |
61 |
60 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
286 |
251 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
163 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
76 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
587 |
578 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
261 |
259 |
$7K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
73 |
64 |
$5K |
| D9310 |
|
39 |
38 |
$581.40 |