| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,664 |
2,584 |
$67K |
| D1110 |
Prophylaxis - adult |
1,208 |
1,175 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,212 |
2,149 |
$35K |
| D4910 |
|
540 |
520 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,258 |
1,212 |
$28K |
| D4341 |
|
569 |
206 |
$27K |
| D1120 |
Prophylaxis - child |
654 |
621 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
580 |
308 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
427 |
367 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
300 |
268 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
93 |
$5K |
| D1206 |
Topical application of fluoride varnish |
396 |
357 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
206 |
163 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
425 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
12 |
$3K |
| D4342 |
|
72 |
29 |
$3K |
| D2140 |
|
60 |
40 |
$2K |
| D2160 |
|
53 |
28 |
$816.00 |
| D0272 |
Bitewings - two radiographic images |
76 |
65 |
$812.36 |
| D2330 |
|
29 |
13 |
$679.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
41 |
$240.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
12 |
$136.00 |
| D0601 |
|
29 |
15 |
$0.00 |