| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
233 |
47 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
404 |
324 |
$11K |
| D1120 |
Prophylaxis - child |
330 |
269 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
947 |
368 |
$8K |
| D1206 |
Topical application of fluoride varnish |
490 |
409 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
368 |
$4K |
| D0274 |
Bitewings - four radiographic images |
151 |
123 |
$4K |
| D1110 |
Prophylaxis - adult |
109 |
84 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
12 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
83 |
82 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
94 |
72 |
$2K |
| D0603 |
|
581 |
483 |
$0.05 |