| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2394 |
|
672 |
383 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
566 |
294 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
455 |
232 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
305 |
$12K |
| D1110 |
Prophylaxis - adult |
267 |
252 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
198 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
313 |
300 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
109 |
98 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
312 |
$4K |
| D0274 |
Bitewings - four radiographic images |
127 |
120 |
$4K |
| D1206 |
Topical application of fluoride varnish |
62 |
61 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
13 |
$544.85 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$390.78 |