| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
906 |
897 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
998 |
988 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,065 |
1,029 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
321 |
$11K |
| D0274 |
Bitewings - four radiographic images |
378 |
374 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
190 |
$9K |
| D1120 |
Prophylaxis - child |
174 |
174 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
198 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
76 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
860 |
675 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
30 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
98 |
71 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
218 |
217 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |