| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
101 |
99 |
$7K |
| D4341 |
|
47 |
14 |
$4K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
28 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
49 |
49 |
$724.03 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
109 |
107 |
$201.80 |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$109.94 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$13.55 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$0.00 |