| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
79 |
$20K |
| D1110 |
Prophylaxis - adult |
263 |
247 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
40 |
$10K |
| D0274 |
Bitewings - four radiographic images |
191 |
185 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
366 |
335 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
159 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
99 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
216 |
206 |
$4K |