| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
124 |
113 |
$4K |
| D0274 |
Bitewings - four radiographic images |
220 |
209 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
255 |
231 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
499 |
220 |
$4K |
| D1206 |
Topical application of fluoride varnish |
245 |
226 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
372 |
349 |
$3K |
| D1120 |
Prophylaxis - child |
130 |
122 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
72 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$890.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$0.00 |
| D1330 |
|
176 |
163 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$0.00 |