| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,774 |
1,402 |
$370K |
| D0210 |
Intraoral - complete series of radiographic images |
2,144 |
2,116 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,172 |
554 |
$90K |
| D1120 |
Prophylaxis - child |
2,507 |
2,469 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,179 |
2,149 |
$74K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
383 |
159 |
$56K |
| D1110 |
Prophylaxis - adult |
934 |
919 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
468 |
267 |
$44K |
| D0145 |
Oral evaluation for a patient under three years of age |
326 |
320 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,894 |
2,862 |
$41K |
| D1351 |
Sealant - per tooth |
1,460 |
445 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,274 |
1,255 |
$35K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
383 |
159 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,246 |
1,228 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,142 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,258 |
1,113 |
$14K |
| D1206 |
Topical application of fluoride varnish |
528 |
510 |
$7K |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$553.76 |
| D0603 |
|
1,790 |
1,743 |
$0.01 |
| D0601 |
|
1,552 |
1,522 |
$0.00 |
| D0602 |
|
497 |
490 |
$0.00 |