| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,171 |
1,002 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
597 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,139 |
989 |
$21K |
| D0274 |
Bitewings - four radiographic images |
863 |
780 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,042 |
940 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
182 |
104 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
843 |
744 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
135 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
24 |
$3K |