| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,667 |
1,693 |
$431K |
| D0120 |
Periodic oral evaluation - established patient |
8,844 |
8,394 |
$236K |
| D1110 |
Prophylaxis - adult |
3,984 |
3,785 |
$201K |
| D0274 |
Bitewings - four radiographic images |
5,846 |
5,551 |
$180K |
| D1120 |
Prophylaxis - child |
5,206 |
4,911 |
$174K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,404 |
9,223 |
$141K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,730 |
9,211 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
10,154 |
9,609 |
$115K |
| D1351 |
Sealant - per tooth |
4,328 |
983 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,459 |
613 |
$104K |
| D0145 |
Oral evaluation for a patient under three years of age |
718 |
664 |
$92K |
| D0272 |
Bitewings - two radiographic images |
2,416 |
2,323 |
$53K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
12 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
126 |
114 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
65 |
30 |
$2K |
| D9222 |
|
30 |
30 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
39 |
$670.60 |
| D0601 |
|
4,394 |
4,170 |
$0.00 |
| D0602 |
|
4,553 |
4,275 |
$0.00 |
| D0603 |
|
1,159 |
1,112 |
$0.00 |