| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
52 |
$6K |
| D0274 |
Bitewings - four radiographic images |
318 |
312 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
291 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
660 |
324 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
371 |
363 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
53 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
12 |
$1K |