| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
753 |
363 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
580 |
562 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
243 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
705 |
681 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
621 |
598 |
$9K |
| D1110 |
Prophylaxis - adult |
327 |
314 |
$9K |
| D0274 |
Bitewings - four radiographic images |
503 |
486 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
333 |
326 |
$4K |
| D1120 |
Prophylaxis - child |
97 |
97 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$589.25 |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
77 |
$557.39 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
18 |
$100.26 |