| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
449 |
256 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
443 |
264 |
$4K |
| D0274 |
Bitewings - four radiographic images |
480 |
281 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
837 |
483 |
$3K |
| D1120 |
Prophylaxis - child |
226 |
136 |
$2K |
| D1206 |
Topical application of fluoride varnish |
360 |
225 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,015 |
430 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
267 |
163 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
14 |
$936.59 |
| D0272 |
Bitewings - two radiographic images |
136 |
76 |
$790.01 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
28 |
$363.19 |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
12 |
$168.88 |
| D0330 |
Panoramic radiographic image |
33 |
16 |
$152.40 |
| D1999 |
|
509 |
213 |
$0.00 |