| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
133 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
95 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
21 |
$3K |
| D1206 |
Topical application of fluoride varnish |
106 |
105 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
112 |
$2K |
| D1120 |
Prophylaxis - child |
58 |
58 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
37 |
37 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$807.42 |
| D0274 |
Bitewings - four radiographic images |
19 |
19 |
$687.99 |