| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,337 |
540 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
645 |
283 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,500 |
2,303 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
924 |
864 |
$4K |
| D0274 |
Bitewings - four radiographic images |
953 |
872 |
$4K |
| D1110 |
Prophylaxis - adult |
467 |
440 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
525 |
479 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,801 |
1,657 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
591 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
67 |
$1K |
| D0272 |
Bitewings - two radiographic images |
181 |
178 |
$855.87 |
| D1120 |
Prophylaxis - child |
95 |
92 |
$828.50 |
| D2950 |
|
89 |
61 |
$440.44 |