| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
406 |
188 |
$50K |
| D1110 |
Prophylaxis - adult |
1,034 |
948 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
875 |
735 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,234 |
1,160 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
902 |
766 |
$34K |
| D1120 |
Prophylaxis - child |
993 |
914 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,262 |
1,142 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
38 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
320 |
268 |
$12K |
| D0272 |
Bitewings - two radiographic images |
204 |
202 |
$5K |
| D0330 |
Panoramic radiographic image |
85 |
73 |
$4K |
| D1206 |
Topical application of fluoride varnish |
42 |
41 |
$971.60 |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
46 |
$934.83 |
| D0140 |
Limited oral evaluation - problem focused |
66 |
63 |
$930.00 |