| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
257 |
253 |
$5K |
| D1120 |
Prophylaxis - child |
232 |
229 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
708 |
692 |
$3K |
| D1110 |
Prophylaxis - adult |
103 |
98 |
$2K |
| D0274 |
Bitewings - four radiographic images |
166 |
165 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
316 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
50 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
184 |
180 |
$984.00 |
| D0603 |
|
160 |
156 |
$930.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$481.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$240.00 |
| D1330 |
|
445 |
421 |
$0.00 |
| D1310 |
|
209 |
198 |
$0.00 |
| D9993 |
|
174 |
164 |
$0.00 |
| D9910 |
|
14 |
14 |
$0.00 |