| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
295 |
291 |
$11K |
| D1120 |
Prophylaxis - child |
228 |
226 |
$9K |
| D1206 |
Topical application of fluoride varnish |
318 |
316 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
204 |
202 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
158 |
$7K |
| D1110 |
Prophylaxis - adult |
136 |
135 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
208 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
47 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
29 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$814.00 |