| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,234 |
4,232 |
$95K |
| D1110 |
Prophylaxis - adult |
1,799 |
1,798 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,549 |
2,548 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,362 |
4,340 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,712 |
3,709 |
$31K |
| D1120 |
Prophylaxis - child |
574 |
574 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
738 |
738 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
130 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
767 |
767 |
$7K |
| D9110 |
|
320 |
317 |
$6K |
| D0272 |
Bitewings - two radiographic images |
422 |
422 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
74 |
$5K |
| D0330 |
Panoramic radiographic image |
70 |
70 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
30 |
$840.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$510.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$182.00 |
| D0270 |
|
17 |
17 |
$127.52 |
| D0180 |
|
29 |
29 |
$0.00 |
| D1330 |
|
584 |
584 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
40 |
40 |
$0.00 |