| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
45 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
37 |
$8K |
| D1206 |
Topical application of fluoride varnish |
59 |
52 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
56 |
$2K |
| D0274 |
Bitewings - four radiographic images |
40 |
34 |
$2K |
| D1120 |
Prophylaxis - child |
35 |
34 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
71 |
64 |
$2K |
| D1110 |
Prophylaxis - adult |
22 |
16 |
$2K |