| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
658 |
323 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
530 |
278 |
$38K |
| D1110 |
Prophylaxis - adult |
792 |
779 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,254 |
1,229 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
961 |
941 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
318 |
310 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
645 |
555 |
$18K |
| D1120 |
Prophylaxis - child |
558 |
553 |
$18K |
| D0274 |
Bitewings - four radiographic images |
435 |
428 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
302 |
$8K |
| D0272 |
Bitewings - two radiographic images |
226 |
222 |
$4K |
| D1351 |
Sealant - per tooth |
92 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
183 |
$2K |