| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,441 |
528 |
$138K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
401 |
141 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,315 |
1,809 |
$38K |
| D1120 |
Prophylaxis - child |
1,148 |
1,111 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,376 |
1,319 |
$35K |
| D1110 |
Prophylaxis - adult |
518 |
494 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,306 |
2,122 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,710 |
1,665 |
$23K |
| D1351 |
Sealant - per tooth |
886 |
175 |
$23K |
| D0274 |
Bitewings - four radiographic images |
676 |
629 |
$18K |
| D0272 |
Bitewings - two radiographic images |
746 |
722 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
83 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
328 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
18 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
61 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$24.71 |
| D1330 |
|
17 |
17 |
$12.25 |
| D0603 |
|
1,760 |
1,704 |
$0.05 |
| D0601 |
|
131 |
120 |
$0.00 |
| D0602 |
|
26 |
26 |
$0.00 |