| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
670 |
653 |
$18K |
| D1120 |
Prophylaxis - child |
377 |
367 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,011 |
957 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
223 |
$5K |
| D0274 |
Bitewings - four radiographic images |
237 |
236 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
38 |
$4K |
| D1110 |
Prophylaxis - adult |
46 |
46 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$1K |
| D9110 |
|
12 |
12 |
$660.00 |
| D0140 |
Limited oral evaluation - problem focused |
37 |
37 |
$601.76 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$312.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
26 |
$150.80 |
| D1999 |
|
23 |
15 |
$0.00 |