| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
114 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
173 |
$5K |
| D1110 |
Prophylaxis - adult |
142 |
141 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
77 |
$4K |
| D0330 |
Panoramic radiographic image |
123 |
122 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
148 |
148 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
253 |
251 |
$2K |
| D0274 |
Bitewings - four radiographic images |
82 |
81 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
138 |
126 |
$832.31 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$261.90 |