| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
357 |
340 |
$6K |
| D1110 |
Prophylaxis - adult |
177 |
175 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
22 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
118 |
112 |
$2K |
| D0274 |
Bitewings - four radiographic images |
76 |
75 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
53 |
$1K |
| D1120 |
Prophylaxis - child |
61 |
57 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
33 |
$919.25 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$870.57 |
| D0220 |
Intraoral - periapical first radiographic image |
37 |
33 |
$152.00 |