| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2332 |
|
3,105 |
1,733 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,062 |
1,082 |
$59K |
| D1110 |
Prophylaxis - adult |
5,312 |
5,261 |
$48K |
| D2335 |
|
932 |
531 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
5,074 |
5,022 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,734 |
935 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,880 |
1,875 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
1,316 |
1,315 |
$19K |
| D2750 |
|
61 |
53 |
$13K |
| D0274 |
Bitewings - four radiographic images |
2,289 |
2,259 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,050 |
2,762 |
$9K |
| D1120 |
Prophylaxis - child |
1,561 |
1,558 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,032 |
2,024 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,852 |
2,805 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
95 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
425 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
243 |
151 |
$3K |
| D1351 |
Sealant - per tooth |
565 |
69 |
$2K |
| D2331 |
|
107 |
62 |
$2K |
| D2954 |
|
12 |
12 |
$540.00 |