| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
347 |
205 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
262 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,853 |
1,828 |
$31K |
| D0274 |
Bitewings - four radiographic images |
974 |
970 |
$29K |
| D1110 |
Prophylaxis - adult |
813 |
787 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
925 |
921 |
$28K |
| D1120 |
Prophylaxis - child |
759 |
756 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
779 |
777 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,933 |
1,891 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
65 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
272 |
119 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
583 |
575 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,881 |
1,382 |
$16K |
| D4910 |
|
49 |
48 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
87 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
21 |
$3K |
| D0272 |
Bitewings - two radiographic images |
107 |
107 |
$3K |
| D4355 |
|
12 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
14 |
$2K |
| D0240 |
|
26 |
13 |
$940.94 |
| D1330 |
|
1,479 |
1,437 |
$361.00 |
| D1354 |
|
61 |
12 |
$56.00 |
| D1310 |
|
282 |
279 |
$0.00 |
| D9986 |
|
254 |
246 |
$0.00 |