| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,264 |
10,220 |
$416K |
| D0120 |
Periodic oral evaluation - established patient |
6,229 |
6,201 |
$397K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,188 |
1,901 |
$281K |
| D0230 |
Intraoral - periapical each additional radiographic image |
53,794 |
10,475 |
$229K |
| D1351 |
Sealant - per tooth |
7,820 |
2,470 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,070 |
3,068 |
$199K |
| D1310 |
|
3,558 |
3,550 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,414 |
10,370 |
$157K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,036 |
465 |
$124K |
| D2140 |
|
2,157 |
1,204 |
$118K |
| D9993 |
|
2,123 |
2,116 |
$105K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
831 |
365 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,108 |
3,091 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
3,661 |
3,651 |
$44K |
| D0272 |
Bitewings - two radiographic images |
3,036 |
3,000 |
$36K |
| D0350 |
|
2,913 |
1,547 |
$30K |
| D0603 |
|
1,949 |
1,946 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
299 |
299 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
307 |
209 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
200 |
192 |
$8K |
| D0601 |
|
329 |
329 |
$5K |
| D0602 |
|
280 |
280 |
$4K |
| D2160 |
|
25 |
19 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |