| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,523 |
3,153 |
$50K |
| D1110 |
Prophylaxis - adult |
1,397 |
1,250 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
538 |
320 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,677 |
2,336 |
$33K |
| D4910 |
|
466 |
437 |
$26K |
| D1120 |
Prophylaxis - child |
1,001 |
870 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,031 |
2,634 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
47 |
27 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,445 |
1,254 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
902 |
756 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
748 |
662 |
$16K |
| D2950 |
|
155 |
119 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
333 |
308 |
$13K |
| D4341 |
|
122 |
37 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,136 |
982 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,962 |
1,287 |
$11K |
| D0330 |
Panoramic radiographic image |
840 |
739 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
126 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
46 |
$4K |
| D1206 |
Topical application of fluoride varnish |
132 |
124 |
$2K |
| D0270 |
|
180 |
167 |
$962.68 |
| D1999 |
|
1,142 |
907 |
$0.00 |