| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
788 |
509 |
$29K |
| D1120 |
Prophylaxis - child |
1,282 |
1,244 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,694 |
1,657 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,894 |
1,855 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
507 |
320 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,022 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,141 |
2,071 |
$12K |
| D1110 |
Prophylaxis - adult |
539 |
531 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,927 |
1,880 |
$10K |
| D1351 |
Sealant - per tooth |
965 |
345 |
$9K |
| D0330 |
Panoramic radiographic image |
253 |
252 |
$6K |
| D0272 |
Bitewings - two radiographic images |
587 |
568 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
302 |
279 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
128 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
122 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
27 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
15 |
12 |
$740.13 |
| D0603 |
|
27 |
27 |
$0.00 |