| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,502 |
4,465 |
$61K |
| D1110 |
Prophylaxis - adult |
2,811 |
2,794 |
$39K |
| D1120 |
Prophylaxis - child |
1,068 |
1,064 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
880 |
876 |
$16K |
| D0272 |
Bitewings - two radiographic images |
2,492 |
2,466 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
3,577 |
3,500 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,596 |
3,348 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,033 |
1,030 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
91 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
342 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
283 |
275 |
$3K |
| D0274 |
Bitewings - four radiographic images |
337 |
332 |
$2K |
| D1351 |
Sealant - per tooth |
89 |
12 |
$1K |
| D9110 |
|
46 |
45 |
$415.50 |