| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,654 |
696 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,390 |
2,384 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
683 |
674 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,021 |
1,017 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,581 |
2,494 |
$29K |
| D1110 |
Prophylaxis - adult |
589 |
587 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
902 |
870 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
324 |
168 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,433 |
1,319 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
58 |
$10K |
| D9110 |
|
175 |
166 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
92 |
$9K |
| D2335 |
|
39 |
13 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
179 |
$3K |
| D2394 |
|
25 |
13 |
$2K |
| D0270 |
|
64 |
64 |
$642.14 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$382.30 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
14 |
$270.12 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$238.75 |