| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,868 |
1,480 |
$192K |
| D4341 |
|
1,374 |
750 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,030 |
898 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,734 |
1,466 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,264 |
917 |
$101K |
| D1120 |
Prophylaxis - child |
1,787 |
1,771 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,869 |
2,822 |
$72K |
| D1351 |
Sealant - per tooth |
1,347 |
502 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
779 |
612 |
$67K |
| D1110 |
Prophylaxis - adult |
1,348 |
1,329 |
$63K |
| D0330 |
Panoramic radiographic image |
2,415 |
2,377 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,086 |
2,064 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,781 |
1,763 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,279 |
2,246 |
$30K |
| D2330 |
|
539 |
316 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
995 |
991 |
$18K |
| D2332 |
|
171 |
134 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
568 |
559 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,523 |
2,432 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,316 |
2,255 |
$6K |
| D2331 |
|
54 |
41 |
$4K |
| D0272 |
Bitewings - two radiographic images |
266 |
264 |
$2K |
| D2335 |
|
13 |
12 |
$1K |