| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
390 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
256 |
254 |
$9K |
| D1206 |
Topical application of fluoride varnish |
217 |
217 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
60 |
34 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
153 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
47 |
$1K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$1K |
| D0603 |
|
97 |
96 |
$957.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
73 |
$666.00 |
| D4910 |
|
12 |
12 |
$630.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$440.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$420.00 |
| D0602 |
|
12 |
12 |
$121.00 |
| D0330 |
Panoramic radiographic image |
45 |
44 |
$52.00 |