| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
867 |
$123K |
| D1110 |
Prophylaxis - adult |
1,220 |
1,220 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
666 |
371 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,361 |
1,361 |
$40K |
| D0330 |
Panoramic radiographic image |
796 |
796 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
269 |
225 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,829 |
1,829 |
$37K |
| D1120 |
Prophylaxis - child |
1,074 |
1,074 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,658 |
1,658 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,764 |
1,726 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
584 |
578 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
236 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
448 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,175 |
1,066 |
$9K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$713.70 |