| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,054 |
534 |
$66K |
| D1110 |
Prophylaxis - adult |
748 |
746 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
219 |
219 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
67 |
$17K |
| D4341 |
|
104 |
34 |
$8K |
| D0330 |
Panoramic radiographic image |
366 |
366 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
398 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
283 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
28 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
105 |
$3K |
| D4910 |
|
28 |
28 |
$2K |
| D2331 |
|
21 |
14 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
561 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
427 |
426 |
$610.59 |
| D0274 |
Bitewings - four radiographic images |
746 |
746 |
$526.10 |
| D1208 |
Topical application of fluoride, excluding varnish |
496 |
495 |
$217.60 |
| D4342 |
|
20 |
12 |
$48.71 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
162 |
$9.22 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
42 |
$0.00 |