| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
193 |
$37K |
| D1120 |
Prophylaxis - child |
506 |
490 |
$21K |
| D1206 |
Topical application of fluoride varnish |
683 |
663 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
527 |
513 |
$16K |
| D0272 |
Bitewings - two radiographic images |
441 |
426 |
$14K |
| D1110 |
Prophylaxis - adult |
116 |
111 |
$8K |
| D0330 |
Panoramic radiographic image |
97 |
96 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
52 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
86 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
111 |
101 |
$5K |
| D1351 |
Sealant - per tooth |
120 |
45 |
$5K |
| D0274 |
Bitewings - four radiographic images |
87 |
87 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
171 |
170 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |