| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
633 |
601 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
316 |
184 |
$21K |
| D0330 |
Panoramic radiographic image |
360 |
348 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
467 |
430 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,075 |
1,018 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
427 |
401 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
518 |
503 |
$9K |
| D1120 |
Prophylaxis - child |
225 |
208 |
$6K |
| D0274 |
Bitewings - four radiographic images |
221 |
211 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
575 |
501 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
40 |
$4K |
| D1206 |
Topical application of fluoride varnish |
241 |
217 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
38 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
38 |
$631.75 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$202.95 |