| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
121 |
$4K |
| D0330 |
Panoramic radiographic image |
94 |
89 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
97 |
91 |
$2K |
| D1110 |
Prophylaxis - adult |
46 |
44 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
16 |
$1K |
| D1120 |
Prophylaxis - child |
31 |
29 |
$513.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
43 |
$468.70 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
12 |
$113.06 |