| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
344 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
449 |
331 |
$66K |
| D0330 |
Panoramic radiographic image |
622 |
604 |
$60K |
| D1206 |
Topical application of fluoride varnish |
1,337 |
1,286 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,300 |
1,253 |
$51K |
| D1120 |
Prophylaxis - child |
995 |
963 |
$50K |
| D1110 |
Prophylaxis - adult |
588 |
558 |
$43K |
| D0274 |
Bitewings - four radiographic images |
621 |
592 |
$31K |
| D0272 |
Bitewings - two radiographic images |
796 |
775 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
341 |
332 |
$23K |
| D1351 |
Sealant - per tooth |
242 |
93 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
541 |
522 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
255 |
169 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
112 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
69 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$568.00 |