| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,092 |
1,041 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
442 |
237 |
$26K |
| D0274 |
Bitewings - four radiographic images |
629 |
611 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
154 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
723 |
698 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
235 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
434 |
412 |
$8K |
| D1330 |
|
890 |
849 |
$8K |
| D1310 |
|
883 |
844 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
162 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
126 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
343 |
332 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$973.60 |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
92 |
$695.42 |
| D9110 |
|
14 |
14 |
$420.00 |