| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,282 |
1,173 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,805 |
1,045 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
5,018 |
4,915 |
$138K |
| D1110 |
Prophylaxis - adult |
2,347 |
2,293 |
$122K |
| D1120 |
Prophylaxis - child |
3,026 |
2,984 |
$108K |
| D0145 |
Oral evaluation for a patient under three years of age |
756 |
741 |
$103K |
| D1351 |
Sealant - per tooth |
3,847 |
1,040 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,713 |
2,661 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,129 |
5,056 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,848 |
4,768 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,763 |
4,635 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,816 |
1,798 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,117 |
1,041 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
212 |
211 |
$14K |
| D0330 |
Panoramic radiographic image |
819 |
804 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
27 |
$4K |
| D0350 |
|
205 |
202 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
38 |
$1K |
| D0170 |
|
14 |
13 |
$213.37 |
| D0603 |
|
5,840 |
5,752 |
$0.00 |
| D0602 |
|
82 |
82 |
$0.00 |