| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
153 |
153 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
119 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
50 |
47 |
$3K |
| D0274 |
Bitewings - four radiographic images |
96 |
96 |
$2K |
| D0330 |
Panoramic radiographic image |
55 |
55 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
65 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19 |
18 |
$1K |
| D1120 |
Prophylaxis - child |
32 |
32 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$989.00 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$722.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$434.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
52 |
49 |
$270.00 |
| D1330 |
|
308 |
307 |
$0.00 |