| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,083 |
616 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,544 |
2,436 |
$59K |
| D1120 |
Prophylaxis - child |
1,818 |
1,743 |
$58K |
| D1110 |
Prophylaxis - adult |
1,155 |
1,089 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
400 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,751 |
1,711 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,282 |
1,207 |
$29K |
| D0330 |
Panoramic radiographic image |
709 |
671 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
959 |
875 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
299 |
$9K |
| D0272 |
Bitewings - two radiographic images |
378 |
356 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
478 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
114 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
35 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
116 |
61 |
$1K |
| D1999 |
|
47 |
42 |
$0.00 |