| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,356 |
852 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,847 |
1,892 |
$64K |
| D1110 |
Prophylaxis - adult |
1,359 |
1,348 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,900 |
1,893 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,543 |
1,539 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,492 |
2,085 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,880 |
1,864 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
925 |
910 |
$29K |
| D4910 |
|
348 |
346 |
$23K |
| D0330 |
Panoramic radiographic image |
612 |
606 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
891 |
885 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
231 |
168 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
52 |
46 |
$4K |
| D0603 |
|
325 |
324 |
$3K |
| D4341 |
|
26 |
12 |
$2K |
| D4355 |
|
26 |
26 |
$2K |
| D1120 |
Prophylaxis - child |
161 |
161 |
$1K |
| D2332 |
|
16 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
297 |
297 |
$969.00 |
| D1351 |
Sealant - per tooth |
70 |
27 |
$630.00 |
| D1330 |
|
68 |
68 |
$340.00 |
| D1999 |
|
108 |
106 |
$322.00 |
| D9630 |
|
15 |
15 |
$247.00 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$236.00 |