| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,192 |
1,160 |
$337K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,407 |
1,048 |
$198K |
| D1351 |
Sealant - per tooth |
5,136 |
1,294 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,658 |
2,568 |
$79K |
| D1120 |
Prophylaxis - child |
2,198 |
2,113 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,577 |
2,961 |
$47K |
| D1110 |
Prophylaxis - adult |
777 |
755 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,586 |
1,521 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,121 |
2,982 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,521 |
1,464 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,028 |
1,952 |
$28K |
| D0274 |
Bitewings - four radiographic images |
838 |
811 |
$25K |
| D0145 |
Oral evaluation for a patient under three years of age |
166 |
165 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
641 |
622 |
$17K |
| D0350 |
|
1,141 |
1,083 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,021 |
991 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
120 |
120 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
36 |
$7K |
| D0330 |
Panoramic radiographic image |
289 |
274 |
$3K |
| D0603 |
|
3,663 |
3,450 |
$0.00 |