| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
306 |
131 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
319 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
87 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
192 |
$5K |
| D1110 |
Prophylaxis - adult |
84 |
80 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
28 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
13 |
$2K |
| D4341 |
|
96 |
20 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
64 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
176 |
$1K |
| D1206 |
Topical application of fluoride varnish |
97 |
91 |
$1K |
| D0274 |
Bitewings - four radiographic images |
90 |
86 |
$810.27 |
| D0230 |
Intraoral - periapical each additional radiographic image |
254 |
144 |
$461.22 |