| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
720 |
524 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
827 |
610 |
$11K |
| D0272 |
Bitewings - two radiographic images |
897 |
642 |
$8K |
| D0330 |
Panoramic radiographic image |
167 |
124 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
88 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
242 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
25 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
48 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
152 |
113 |
$544.22 |
| D9110 |
|
54 |
24 |
$378.84 |