| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,402 |
436 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
878 |
257 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,709 |
1,272 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,324 |
1,316 |
$37K |
| D1110 |
Prophylaxis - adult |
685 |
671 |
$36K |
| D1120 |
Prophylaxis - child |
769 |
761 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,670 |
1,641 |
$23K |
| D0145 |
Oral evaluation for a patient under three years of age |
157 |
157 |
$20K |
| D0274 |
Bitewings - four radiographic images |
499 |
497 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,378 |
1,361 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
179 |
170 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
355 |
329 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
182 |
$6K |
| D2330 |
|
91 |
26 |
$5K |
| D0272 |
Bitewings - two radiographic images |
194 |
194 |
$4K |
| D1351 |
Sealant - per tooth |
85 |
12 |
$2K |
| D0603 |
|
2,271 |
2,196 |
$0.00 |