| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
380 |
127 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
586 |
562 |
$16K |
| D1120 |
Prophylaxis - child |
452 |
429 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
697 |
671 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
530 |
506 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
676 |
640 |
$7K |
| D1110 |
Prophylaxis - adult |
139 |
135 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
78 |
$5K |
| D1351 |
Sealant - per tooth |
216 |
43 |
$5K |
| D1206 |
Topical application of fluoride varnish |
322 |
313 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
94 |
$3K |
| D0272 |
Bitewings - two radiographic images |
103 |
103 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
16 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
43 |
42 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
18 |
$677.75 |
| D0603 |
|
1,427 |
1,390 |
$0.00 |