| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
793 |
282 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,113 |
$31K |
| D1120 |
Prophylaxis - child |
901 |
867 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,644 |
1,581 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,092 |
1,578 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,703 |
1,646 |
$20K |
| D0272 |
Bitewings - two radiographic images |
822 |
798 |
$18K |
| D1110 |
Prophylaxis - adult |
302 |
292 |
$15K |
| D0274 |
Bitewings - four radiographic images |
386 |
374 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
12 |
$11K |
| D1351 |
Sealant - per tooth |
345 |
77 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
236 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
53 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
53 |
52 |
$6K |
| D0602 |
|
1,687 |
1,641 |
$0.00 |
| D0601 |
|
40 |
40 |
$0.00 |