| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
1,036 |
970 |
$76K |
| D1110 |
Prophylaxis - adult |
750 |
750 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
666 |
666 |
$9K |
| D0274 |
Bitewings - four radiographic images |
606 |
606 |
$8K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
83 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
885 |
881 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
707 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
43 |
42 |
$586.60 |
| D1310 |
|
18 |
18 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |