| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,966 |
1,966 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
971 |
668 |
$91K |
| D0330 |
Panoramic radiographic image |
1,369 |
1,369 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,521 |
2,521 |
$58K |
| D1120 |
Prophylaxis - child |
1,632 |
1,632 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,607 |
2,607 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,792 |
2,792 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
941 |
941 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
768 |
763 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
154 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
68 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
545 |
$7K |
| D0274 |
Bitewings - four radiographic images |
114 |
114 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
24 |
$3K |