| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
364 |
344 |
$6K |
| D1110 |
Prophylaxis - adult |
221 |
216 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
310 |
293 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
596 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
847 |
533 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
43 |
$3K |
| D1120 |
Prophylaxis - child |
170 |
166 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
233 |
229 |
$3K |
| D1206 |
Topical application of fluoride varnish |
248 |
242 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
26 |
$470.83 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$333.97 |
| D1999 |
|
429 |
372 |
$0.00 |