| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,385 |
949 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
842 |
411 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,566 |
1,560 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
1,500 |
1,478 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,477 |
1,472 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
3,198 |
3,113 |
$7K |
| D1110 |
Prophylaxis - adult |
888 |
888 |
$6K |
| D1120 |
Prophylaxis - child |
824 |
817 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,267 |
1,262 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,837 |
2,035 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
573 |
423 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
861 |
855 |
$3K |
| D1206 |
Topical application of fluoride varnish |
750 |
748 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
77 |
$2K |
| D1351 |
Sealant - per tooth |
198 |
91 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
158 |
158 |
$812.00 |
| D0272 |
Bitewings - two radiographic images |
146 |
145 |
$560.00 |
| D0240 |
|
53 |
26 |
$128.00 |
| D2330 |
|
16 |
12 |
$116.00 |
| D4910 |
|
12 |
12 |
$70.00 |
| D1330 |
|
1,603 |
1,579 |
$40.11 |
| D1310 |
|
60 |
60 |
$10.01 |
| D9986 |
|
1,021 |
994 |
$0.00 |