| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,393 |
1,393 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,678 |
1,678 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,131 |
2,131 |
$43K |
| D4910 |
|
479 |
479 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
363 |
237 |
$36K |
| D0274 |
Bitewings - four radiographic images |
829 |
829 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
570 |
570 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
399 |
399 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
186 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,495 |
1,471 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,287 |
1,116 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
352 |
346 |
$14K |
| D4341 |
|
81 |
40 |
$10K |
| D0603 |
|
415 |
415 |
$5K |
| D0602 |
|
291 |
291 |
$3K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$2K |
| D1330 |
|
126 |
126 |
$156.00 |