| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
428 |
425 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
94 |
$14K |
| D1110 |
Prophylaxis - adult |
406 |
404 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
352 |
352 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
591 |
589 |
$6K |
| D0274 |
Bitewings - four radiographic images |
293 |
293 |
$5K |
| D1120 |
Prophylaxis - child |
257 |
257 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
47 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
38 |
$742.00 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
48 |
$408.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$266.00 |