| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
696 |
$82K |
| D1110 |
Prophylaxis - adult |
1,676 |
1,672 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,533 |
2,523 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,718 |
1,714 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
663 |
418 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
627 |
627 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
914 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
844 |
805 |
$29K |
| D4341 |
|
283 |
105 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
312 |
156 |
$25K |
| D1120 |
Prophylaxis - child |
592 |
590 |
$23K |
| D0274 |
Bitewings - four radiographic images |
898 |
893 |
$23K |
| D4910 |
|
235 |
235 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
152 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,084 |
1,041 |
$14K |
| D0272 |
Bitewings - two radiographic images |
179 |
178 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
314 |
295 |
$3K |
| D2331 |
|
30 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
52 |
$1K |
| D0270 |
|
106 |
106 |
$1K |