| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
911 |
312 |
$74K |
| D1110 |
Prophylaxis - adult |
1,522 |
1,488 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
922 |
891 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
582 |
561 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
894 |
892 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,244 |
1,216 |
$15K |
| D0274 |
Bitewings - four radiographic images |
467 |
463 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,027 |
767 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
168 |
68 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
92 |
$3K |
| D4910 |
|
38 |
38 |
$3K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$250.00 |