| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,143 |
940 |
$277K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,518 |
781 |
$170K |
| D1351 |
Sealant - per tooth |
3,394 |
920 |
$79K |
| D1120 |
Prophylaxis - child |
1,816 |
1,760 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,023 |
1,938 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,327 |
2,595 |
$56K |
| D1110 |
Prophylaxis - adult |
741 |
703 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,745 |
2,618 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,169 |
1,121 |
$28K |
| D0274 |
Bitewings - four radiographic images |
847 |
804 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,790 |
1,736 |
$25K |
| D0350 |
|
1,474 |
1,407 |
$23K |
| D0272 |
Bitewings - two radiographic images |
961 |
927 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
708 |
693 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
693 |
657 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
40 |
40 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
13 |
$5K |
| D0330 |
Panoramic radiographic image |
259 |
239 |
$3K |
| D0603 |
|
3,091 |
2,886 |
$0.00 |