| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
943 |
485 |
$63K |
| D1110 |
Prophylaxis - adult |
754 |
753 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,099 |
1,093 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
467 |
450 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
589 |
488 |
$15K |
| D0274 |
Bitewings - four radiographic images |
499 |
498 |
$13K |
| D1206 |
Topical application of fluoride varnish |
620 |
614 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
601 |
$7K |
| D1120 |
Prophylaxis - child |
180 |
176 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
68 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
27 |
$2K |
| D2331 |
|
20 |
13 |
$1K |
| D1999 |
|
161 |
123 |
$1K |
| D4910 |
|
12 |
12 |
$848.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
25 |
$308.00 |