| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,012 |
476 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
752 |
346 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,509 |
1,506 |
$35K |
| D1110 |
Prophylaxis - adult |
748 |
743 |
$30K |
| D1120 |
Prophylaxis - child |
735 |
732 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
843 |
840 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
524 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
322 |
313 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
264 |
108 |
$15K |
| D0274 |
Bitewings - four radiographic images |
538 |
536 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,186 |
1,168 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
384 |
380 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,103 |
982 |
$7K |
| D0272 |
Bitewings - two radiographic images |
169 |
169 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
77 |
27 |
$2K |