| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
306 |
306 |
$10K |
| D0274 |
Bitewings - four radiographic images |
280 |
280 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
49 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
141 |
51 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
273 |
272 |
$5K |
| D0330 |
Panoramic radiographic image |
133 |
132 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
221 |
221 |
$4K |
| D9110 |
|
139 |
139 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
410 |
405 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
265 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
54 |
$1K |