| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,456 |
1,429 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
1,479 |
1,449 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
483 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
289 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
515 |
500 |
$13K |
| D1110 |
Prophylaxis - adult |
294 |
287 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
326 |
$7K |
| D0274 |
Bitewings - four radiographic images |
341 |
334 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
70 |
$4K |
| D0272 |
Bitewings - two radiographic images |
247 |
238 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
103 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
177 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$395.10 |