| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D8670 |
Periodic orthodontic treatment visit |
215 |
214 |
$24K |
| D0274 |
Bitewings - four radiographic images |
418 |
408 |
$12K |
| D1110 |
Prophylaxis - adult |
313 |
309 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
99 |
$10K |
| D0330 |
Panoramic radiographic image |
246 |
243 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
364 |
352 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
60 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
182 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
378 |
$3K |
| D9110 |
|
90 |
88 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
98 |
$2K |
| D2330 |
|
30 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
44 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$768.00 |
| D1120 |
Prophylaxis - child |
21 |
21 |
$630.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$616.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
27 |
$312.00 |