| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,686 |
776 |
$286K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,823 |
5,697 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
4,818 |
4,695 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
907 |
332 |
$124K |
| D1110 |
Prophylaxis - adult |
2,780 |
2,678 |
$105K |
| D0220 |
Intraoral - periapical first radiographic image |
6,104 |
5,904 |
$92K |
| D1206 |
Topical application of fluoride varnish |
5,545 |
5,375 |
$89K |
| D1120 |
Prophylaxis - child |
3,229 |
3,157 |
$89K |
| D0330 |
Panoramic radiographic image |
1,073 |
1,038 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
729 |
307 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,366 |
1,334 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,936 |
1,846 |
$58K |
| D1351 |
Sealant - per tooth |
1,365 |
320 |
$38K |
| D0272 |
Bitewings - two radiographic images |
910 |
898 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
363 |
347 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
12 |
$10K |
| D2331 |
|
71 |
27 |
$6K |
| D4355 |
|
70 |
69 |
$5K |
| D1999 |
|
1,056 |
860 |
$0.00 |