| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,321 |
1,293 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
537 |
262 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,401 |
1,384 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,136 |
1,112 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
361 |
252 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
697 |
693 |
$11K |
| D1320 |
|
654 |
637 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
99 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
910 |
852 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
146 |
$4K |
| D1120 |
Prophylaxis - child |
132 |
132 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
80 |
71 |
$2K |
| D2140 |
|
15 |
12 |
$597.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
24 |
$155.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$150.00 |