| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
599 |
565 |
$14K |
| D1120 |
Prophylaxis - child |
331 |
314 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
448 |
423 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
70 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
46 |
39 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$884.40 |