| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,237 |
900 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
5,517 |
5,407 |
$152K |
| D1110 |
Prophylaxis - adult |
2,088 |
2,045 |
$109K |
| D1120 |
Prophylaxis - child |
3,000 |
2,944 |
$105K |
| D1351 |
Sealant - per tooth |
3,681 |
684 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,903 |
5,136 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,620 |
5,509 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,441 |
5,325 |
$66K |
| D0272 |
Bitewings - two radiographic images |
2,648 |
2,611 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,781 |
1,732 |
$57K |
| D0145 |
Oral evaluation for a patient under three years of age |
337 |
335 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
73 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
92 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
210 |
191 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$2K |
| D0601 |
|
712 |
704 |
$0.00 |
| D0603 |
|
3,963 |
3,898 |
$0.00 |
| D0602 |
|
1,252 |
1,233 |
$0.00 |