| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,307 |
1,301 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
356 |
292 |
$21K |
| D1110 |
Prophylaxis - adult |
341 |
341 |
$16K |
| D1120 |
Prophylaxis - child |
355 |
355 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
322 |
322 |
$8K |
| D0274 |
Bitewings - four radiographic images |
353 |
346 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
206 |
205 |
$6K |
| D4341 |
|
30 |
14 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
329 |
297 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
75 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
713 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
550 |
541 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
125 |
108 |
$3K |
| D9110 |
|
27 |
27 |
$1K |