| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,185 |
3,055 |
$705K |
| D1110 |
Prophylaxis - adult |
8,109 |
7,309 |
$455K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,566 |
11,987 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
11,114 |
10,018 |
$349K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,093 |
2,103 |
$347K |
| D0210 |
Intraoral - complete series of radiographic images |
3,554 |
3,173 |
$337K |
| D1120 |
Prophylaxis - child |
6,929 |
6,115 |
$316K |
| D1351 |
Sealant - per tooth |
6,006 |
1,498 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,809 |
5,033 |
$238K |
| D0274 |
Bitewings - four radiographic images |
5,999 |
5,365 |
$200K |
| D0220 |
Intraoral - periapical first radiographic image |
10,497 |
9,217 |
$162K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,104 |
644 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,740 |
707 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,376 |
7,713 |
$116K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
943 |
767 |
$84K |
| D0272 |
Bitewings - two radiographic images |
2,011 |
1,827 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,682 |
1,502 |
$62K |
| D1206 |
Topical application of fluoride varnish |
758 |
734 |
$27K |
| D4355 |
|
26 |
26 |
$5K |
| D2394 |
|
17 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
39 |
36 |
$3K |
| D2332 |
|
23 |
12 |
$3K |
| D2335 |
|
16 |
12 |
$984.80 |