| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,940 |
1,927 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,604 |
1,586 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
335 |
184 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,087 |
1,075 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
118 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,391 |
2,336 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,099 |
2,070 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
102 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
63 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
312 |
302 |
$12K |
| D0330 |
Panoramic radiographic image |
168 |
167 |
$8K |
| D2330 |
|
49 |
24 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
213 |
213 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
98 |
$4K |