| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
894 |
837 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
737 |
649 |
$0.00 |
| D0603 |
|
632 |
561 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
534 |
371 |
$0.00 |
| D1330 |
|
1,718 |
1,557 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
807 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
483 |
449 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
606 |
553 |
$0.00 |
| D1310 |
|
855 |
786 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
919 |
695 |
$0.00 |
| D0602 |
|
486 |
428 |
$0.00 |
| D0601 |
|
102 |
94 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
36 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
203 |
99 |
$0.00 |
| D4342 |
|
17 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
77 |
62 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
781 |
710 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
174 |
133 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,569 |
1,461 |
$0.00 |
| D1120 |
Prophylaxis - child |
405 |
378 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,047 |
948 |
$0.00 |
| D0270 |
|
291 |
288 |
$0.00 |
| D0330 |
Panoramic radiographic image |
43 |
37 |
$0.00 |
| D4341 |
|
51 |
28 |
$0.00 |
| D4910 |
|
13 |
13 |
$0.00 |