| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,725 |
726 |
$134K |
| D2332 |
|
796 |
276 |
$77K |
| D4341 |
|
968 |
388 |
$77K |
| D2394 |
|
726 |
440 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
989 |
525 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,634 |
1,492 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
754 |
480 |
$49K |
| D1110 |
Prophylaxis - adult |
1,098 |
1,092 |
$47K |
| D0274 |
Bitewings - four radiographic images |
914 |
913 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,811 |
1,199 |
$23K |
| D2335 |
|
219 |
115 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,747 |
1,586 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,154 |
1,141 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
385 |
$14K |
| D4910 |
|
226 |
220 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
509 |
505 |
$13K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$988.00 |