| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,237 |
9,655 |
$414K |
| D1351 |
Sealant - per tooth |
5,122 |
2,667 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
10,732 |
10,120 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,706 |
2,108 |
$165K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,876 |
4,563 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,614 |
4,399 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,625 |
2,091 |
$105K |
| D1110 |
Prophylaxis - adult |
2,141 |
2,053 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,984 |
3,765 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
8,066 |
7,513 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
428 |
326 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
999 |
962 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,314 |
1,257 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,959 |
6,479 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
494 |
393 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,198 |
2,034 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,215 |
1,148 |
$20K |
| D4341 |
|
47 |
26 |
$9K |