| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
774 |
748 |
$17K |
| D1110 |
Prophylaxis - adult |
262 |
253 |
$10K |
| D0330 |
Panoramic radiographic image |
233 |
226 |
$8K |
| D1120 |
Prophylaxis - child |
180 |
174 |
$8K |
| D0274 |
Bitewings - four radiographic images |
198 |
190 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
42 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
205 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$297.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$252.42 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
15 |
$108.88 |
| D1999 |
|
102 |
87 |
$0.00 |