| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
237 |
229 |
$5K |
| D1120 |
Prophylaxis - child |
193 |
186 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
43 |
$4K |
| D1110 |
Prophylaxis - adult |
143 |
140 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
378 |
$3K |
| D0274 |
Bitewings - four radiographic images |
172 |
170 |
$3K |
| D1206 |
Topical application of fluoride varnish |
221 |
214 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
390 |
336 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
138 |
137 |
$2K |
| D0272 |
Bitewings - two radiographic images |
144 |
137 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$921.57 |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$854.27 |