| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
679 |
634 |
$16K |
| D0330 |
Panoramic radiographic image |
310 |
303 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
159 |
38 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
156 |
$8K |
| D1110 |
Prophylaxis - adult |
179 |
170 |
$5K |
| D0274 |
Bitewings - four radiographic images |
157 |
151 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
76 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
71 |
$990.00 |
| D1120 |
Prophylaxis - child |
29 |
28 |
$500.00 |
| D0120 |
Periodic oral evaluation - established patient |
15 |
15 |
$256.20 |