| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,937 |
2,565 |
$290K |
| D4341 |
|
1,612 |
700 |
$124K |
| D2160 |
|
979 |
792 |
$64K |
| D2332 |
|
577 |
355 |
$47K |
| D1110 |
Prophylaxis - adult |
1,092 |
1,089 |
$37K |
| D2140 |
|
597 |
459 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,680 |
1,678 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,021 |
1,021 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
851 |
851 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
363 |
261 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
462 |
461 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
576 |
568 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,927 |
1,911 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
78 |
$8K |
| D0274 |
Bitewings - four radiographic images |
914 |
914 |
$8K |
| D1120 |
Prophylaxis - child |
287 |
287 |
$7K |
| D0330 |
Panoramic radiographic image |
735 |
725 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,850 |
1,209 |
$5K |
| D2330 |
|
52 |
41 |
$2K |
| D4910 |
|
38 |
38 |
$2K |
| D0601 |
|
287 |
286 |
$1K |
| D2161 |
|
13 |
13 |
$1K |
| D0602 |
|
103 |
103 |
$583.00 |
| D0272 |
Bitewings - two radiographic images |
65 |
65 |
$560.00 |
| D0603 |
|
71 |
71 |
$451.00 |
| D1999 |
|
55 |
55 |
$385.00 |
| D1330 |
|
490 |
490 |
$140.00 |
| D1310 |
|
490 |
489 |
$0.00 |