| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,722 |
1,664 |
$59K |
| D1110 |
Prophylaxis - adult |
1,235 |
1,235 |
$56K |
| D0274 |
Bitewings - four radiographic images |
994 |
993 |
$27K |
| D0330 |
Panoramic radiographic image |
337 |
335 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
671 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
240 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
26 |
$5K |
| D0180 |
|
72 |
72 |
$3K |
| D4341 |
|
29 |
13 |
$3K |
| D1999 |
|
80 |
71 |
$539.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
26 |
$207.00 |