| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,168 |
2,147 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,139 |
2,115 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,062 |
1,053 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
324 |
150 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
341 |
263 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
935 |
927 |
$17K |
| D1120 |
Prophylaxis - child |
536 |
532 |
$16K |
| D0330 |
Panoramic radiographic image |
378 |
377 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
254 |
196 |
$13K |
| D1330 |
|
850 |
846 |
$9K |
| D1310 |
|
858 |
854 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
79 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
262 |
$5K |
| D2331 |
|
52 |
46 |
$3K |
| D0272 |
Bitewings - two radiographic images |
175 |
175 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
146 |
$1K |
| D2330 |
|
17 |
13 |
$900.00 |