| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,788 |
2,612 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,421 |
1,064 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,882 |
3,645 |
$78K |
| D0274 |
Bitewings - four radiographic images |
3,005 |
2,827 |
$69K |
| D1206 |
Topical application of fluoride varnish |
3,209 |
3,023 |
$56K |
| D1120 |
Prophylaxis - child |
2,315 |
2,206 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
747 |
559 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,193 |
1,156 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
546 |
347 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,625 |
1,551 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
760 |
705 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,573 |
2,386 |
$15K |
| D0330 |
Panoramic radiographic image |
296 |
292 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,781 |
902 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
108 |
$8K |
| D1351 |
Sealant - per tooth |
118 |
37 |
$3K |
| D2331 |
|
16 |
12 |
$971.37 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$963.90 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$244.50 |