| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,359 |
1,275 |
$26K |
| D1110 |
Prophylaxis - adult |
952 |
835 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,532 |
1,448 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,776 |
1,655 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
427 |
291 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
290 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
743 |
637 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
123 |
$9K |
| D0274 |
Bitewings - four radiographic images |
608 |
524 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
405 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
128 |
118 |
$4K |
| D0330 |
Panoramic radiographic image |
132 |
110 |
$4K |
| D0272 |
Bitewings - two radiographic images |
303 |
295 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
514 |
450 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
12 |
$3K |
| D9420 |
|
37 |
26 |
$0.00 |