Aim: The aim of the study was to determine the frequency of type II carious lesions in the first permanent molars and their possible relationship with the pulp in clinical and radiological examinations. Methods: Two hundred forty-two patients were examined at the Dental department of Punjab Dental Hospital, Lahore for one-year duration from June 2019 to June 2020. Results and Conclusion: This study showed that 62% of the respondents had a type II carious cavity. In the maxilla, unilateral class II carious lesions accounted for 19%, and bilateral 2.5%, while in the mandible, unilateral 36.4% and bilateral 4.1%, respectively. Class II carious lesions were more common in females and in mandibular molars. In terms of pulp exposure, there was a significant relationship between clinical and radiological examination. Key words: Caries of the first-class II molars, Incidence