| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
363 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,304 |
1,292 |
$40K |
| D1120 |
Prophylaxis - child |
1,290 |
1,278 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,691 |
1,043 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,526 |
1,510 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
200 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
420 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,149 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
585 |
546 |
$14K |
| D1110 |
Prophylaxis - adult |
238 |
234 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
76 |
$7K |
| D0272 |
Bitewings - two radiographic images |
290 |
287 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
122 |
$4K |
| D0274 |
Bitewings - four radiographic images |
156 |
154 |
$4K |