| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,339 |
4,326 |
$150K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,674 |
872 |
$123K |
| D0274 |
Bitewings - four radiographic images |
2,461 |
2,456 |
$72K |
| D1120 |
Prophylaxis - child |
2,093 |
2,088 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,422 |
3,415 |
$63K |
| D0340 |
|
1,460 |
1,456 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,033 |
3,991 |
$45K |
| D1110 |
Prophylaxis - adult |
977 |
977 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
714 |
395 |
$39K |
| D0330 |
Panoramic radiographic image |
780 |
774 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
685 |
676 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,199 |
3,123 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
637 |
623 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
806 |
805 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
89 |
$14K |
| D0272 |
Bitewings - two radiographic images |
265 |
265 |
$6K |
| D4341 |
|
30 |
13 |
$3K |
| D4346 |
|
27 |
27 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
14 |
$2K |
| D0270 |
|
24 |
24 |
$243.99 |