| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,044 |
1,019 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,650 |
1,611 |
$36K |
| D1120 |
Prophylaxis - child |
507 |
502 |
$24K |
| D0274 |
Bitewings - four radiographic images |
774 |
755 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
322 |
191 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,250 |
1,221 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,304 |
1,259 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
323 |
315 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,252 |
1,041 |
$9K |
| D4341 |
|
107 |
29 |
$8K |
| D0330 |
Panoramic radiographic image |
155 |
153 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
53 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
85 |
80 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
79 |
76 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
19 |
19 |
$544.50 |