| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
387 |
$46K |
| D1110 |
Prophylaxis - adult |
804 |
802 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
1,025 |
$27K |
| D1206 |
Topical application of fluoride varnish |
902 |
899 |
$17K |
| D0274 |
Bitewings - four radiographic images |
442 |
440 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
265 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
322 |
275 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
314 |
306 |
$4K |
| D1120 |
Prophylaxis - child |
76 |
76 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
57 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
24 |
$2K |
| D4910 |
|
27 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$686.00 |