| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
1,060 |
$29K |
| D1110 |
Prophylaxis - adult |
627 |
627 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,127 |
1,125 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
770 |
751 |
$10K |
| D0274 |
Bitewings - four radiographic images |
222 |
221 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
491 |
359 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$2K |
| D4910 |
|
28 |
28 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D1999 |
|
413 |
362 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$754.00 |
| D0603 |
|
52 |
52 |
$561.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$532.00 |
| D0602 |
|
38 |
38 |
$418.00 |