| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
766 |
760 |
$33K |
| D1206 |
Topical application of fluoride varnish |
760 |
745 |
$21K |
| D0274 |
Bitewings - four radiographic images |
626 |
620 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
141 |
79 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
459 |
450 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
411 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
348 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,273 |
1,233 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,601 |
728 |
$8K |
| D0330 |
Panoramic radiographic image |
242 |
240 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
31 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$2K |
| D1999 |
|
183 |
176 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$1K |
| D0270 |
|
12 |
12 |
$118.17 |
| D9986 |
|
239 |
237 |
$0.00 |