| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,411 |
1,126 |
$163K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,377 |
574 |
$159K |
| D0210 |
Intraoral - complete series of radiographic images |
1,295 |
1,291 |
$121K |
| D1110 |
Prophylaxis - adult |
2,090 |
2,078 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
3,064 |
3,048 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,581 |
1,338 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,560 |
3,416 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,721 |
$22K |
| D1351 |
Sealant - per tooth |
2,017 |
619 |
$13K |
| D1120 |
Prophylaxis - child |
2,968 |
2,958 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,019 |
4,996 |
$12K |
| D2394 |
|
32 |
16 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
978 |
335 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
349 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,662 |
1,651 |
$4K |
| D1330 |
|
4,743 |
4,722 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,801 |
3,749 |
$3K |
| D0603 |
|
4,904 |
4,881 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
45 |
$1K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
1,032 |
$1K |
| D7111 |
|
179 |
110 |
$729.15 |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$625.00 |