| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,621 |
2,791 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
990 |
575 |
$82K |
| D1120 |
Prophylaxis - child |
3,573 |
3,077 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,299 |
1,656 |
$61K |
| D0330 |
Panoramic radiographic image |
1,454 |
1,268 |
$56K |
| D1351 |
Sealant - per tooth |
3,551 |
405 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,613 |
2,953 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
583 |
280 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,196 |
1,012 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
492 |
484 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
650 |
526 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
39 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
59 |
$979.74 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$192.78 |