| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,212 |
1,151 |
$27K |
| D1110 |
Prophylaxis - adult |
1,347 |
704 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,751 |
875 |
$13K |
| D1120 |
Prophylaxis - child |
1,022 |
519 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,486 |
704 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
198 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,144 |
441 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
184 |
80 |
$3K |
| D0274 |
Bitewings - four radiographic images |
205 |
91 |
$2K |
| D0330 |
Panoramic radiographic image |
92 |
42 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
28 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
12 |
$975.00 |