| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,370 |
3,290 |
$604.50 |
| D1110 |
Prophylaxis - adult |
2,989 |
2,914 |
$326.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,514 |
2,449 |
$282.00 |
| D0220 |
Intraoral - periapical first radiographic image |
5,199 |
4,913 |
$193.38 |
| D0140 |
Limited oral evaluation - problem focused |
2,262 |
2,198 |
$149.30 |
| D0120 |
Periodic oral evaluation - established patient |
1,802 |
1,745 |
$111.00 |
| D0274 |
Bitewings - four radiographic images |
2,477 |
2,386 |
$108.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,193 |
3,830 |
$93.75 |
| D4341 |
|
850 |
420 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,764 |
780 |
$0.00 |
| D1120 |
Prophylaxis - child |
333 |
328 |
$0.00 |
| D1999 |
|
373 |
347 |
$0.00 |
| D2954 |
|
115 |
99 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
628 |
416 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
302 |
297 |
$0.00 |
| D2750 |
|
94 |
80 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
126 |
123 |
$0.00 |
| D2330 |
|
60 |
28 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
13 |
$0.00 |