| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,566 |
1,535 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,731 |
2,695 |
$57K |
| D1120 |
Prophylaxis - child |
1,733 |
1,710 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,866 |
2,831 |
$46K |
| D0274 |
Bitewings - four radiographic images |
951 |
923 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
843 |
834 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
148 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
416 |
393 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
556 |
$9K |
| D0272 |
Bitewings - two radiographic images |
477 |
469 |
$9K |
| D0330 |
Panoramic radiographic image |
133 |
127 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
24 |
$6K |
| D1351 |
Sealant - per tooth |
170 |
42 |
$4K |
| D2330 |
|
39 |
29 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
15 |
$955.04 |