| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
118 |
110 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
80 |
78 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
73 |
26 |
$6K |
| D1110 |
Prophylaxis - adult |
204 |
195 |
$3K |
| D0274 |
Bitewings - four radiographic images |
281 |
271 |
$3K |
| D2140 |
|
34 |
16 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
578 |
$2K |
| D2160 |
|
35 |
16 |
$907.58 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$719.29 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,047 |
366 |
$285.76 |
| D0330 |
Panoramic radiographic image |
56 |
50 |
$27.73 |
| D1206 |
Topical application of fluoride varnish |
32 |
30 |
$0.00 |