| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
954 |
934 |
$31K |
| D1120 |
Prophylaxis - child |
983 |
962 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,023 |
1,000 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
387 |
207 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,390 |
1,358 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,272 |
2,171 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,079 |
1,963 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
386 |
358 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
381 |
372 |
$8K |
| D1110 |
Prophylaxis - adult |
214 |
198 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
94 |
46 |
$7K |
| D2140 |
|
79 |
61 |
$4K |
| D0272 |
Bitewings - two radiographic images |
210 |
202 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
138 |
121 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
26 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |