| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
600 |
542 |
$274K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,117 |
3,091 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
3,063 |
3,050 |
$158K |
| D1110 |
Prophylaxis - adult |
1,446 |
1,445 |
$119K |
| D1120 |
Prophylaxis - child |
2,651 |
2,637 |
$93K |
| D3320 |
|
238 |
210 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
1,566 |
1,549 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,270 |
4,253 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,925 |
1,914 |
$40K |
| D2394 |
|
401 |
350 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
431 |
291 |
$23K |
| D3310 |
|
63 |
39 |
$19K |
| D1351 |
Sealant - per tooth |
878 |
202 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
105 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
966 |
$11K |
| D9430 |
|
155 |
152 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
663 |
377 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$192.00 |
| D1330 |
|
44 |
44 |
$0.00 |