| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
666 |
634 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
397 |
$18K |
| D4341 |
|
299 |
93 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
155 |
63 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
965 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
92 |
24 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
34 |
$5K |
| D1206 |
Topical application of fluoride varnish |
232 |
213 |
$5K |
| D0274 |
Bitewings - four radiographic images |
294 |
290 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
61 |
61 |
$2K |
| D1110 |
Prophylaxis - adult |
40 |
34 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
217 |
207 |
$568.98 |