| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,687 |
3,479 |
$395K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,188 |
2,167 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
6,268 |
6,064 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,593 |
5,117 |
$112K |
| D1120 |
Prophylaxis - child |
4,015 |
3,895 |
$106K |
| D1999 |
|
5,216 |
4,784 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,820 |
5,629 |
$83K |
| D1110 |
Prophylaxis - adult |
2,349 |
2,257 |
$81K |
| D0330 |
Panoramic radiographic image |
1,272 |
1,211 |
$52K |
| D0272 |
Bitewings - two radiographic images |
996 |
965 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
242 |
165 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
269 |
244 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
56 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
15 |
$456.75 |