| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,947 |
2,928 |
$57K |
| D1110 |
Prophylaxis - adult |
1,048 |
1,039 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
292 |
290 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
168 |
$12K |
| D0274 |
Bitewings - four radiographic images |
441 |
435 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
487 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
134 |
$9K |
| D1120 |
Prophylaxis - child |
279 |
276 |
$8K |
| D9110 |
|
212 |
207 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$6K |
| D1206 |
Topical application of fluoride varnish |
263 |
263 |
$5K |
| D2330 |
|
50 |
38 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
270 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$2K |
| D2331 |
|
23 |
14 |
$1K |
| D2332 |
|
17 |
12 |
$1K |
| D1310 |
|
105 |
105 |
$1K |
| D1330 |
|
105 |
105 |
$997.20 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$782.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
14 |
$168.32 |
| D1999 |
|
34 |
18 |
$20.00 |
| D9996 |
|
108 |
107 |
$0.00 |
| D0190 |
|
108 |
107 |
$0.00 |