| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
524 |
280 |
$73K |
| D1110 |
Prophylaxis - adult |
1,183 |
1,160 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,039 |
1,021 |
$33K |
| D1206 |
Topical application of fluoride varnish |
614 |
592 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
572 |
$13K |
| D0274 |
Bitewings - four radiographic images |
801 |
787 |
$12K |
| D2750 |
|
15 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
877 |
854 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
94 |
$5K |
| D1120 |
Prophylaxis - child |
103 |
100 |
$4K |
| D1351 |
Sealant - per tooth |
118 |
14 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
102 |
$4K |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
595 |
528 |
$3K |
| D1330 |
|
59 |
58 |
$342.00 |