| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
89 |
75 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
45 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
100 |
83 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
71 |
$2K |
| D0274 |
Bitewings - four radiographic images |
74 |
66 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
43 |
$842.00 |
| D0140 |
Limited oral evaluation - problem focused |
60 |
46 |
$696.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
14 |
$586.15 |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
68 |
$397.60 |
| D1110 |
Prophylaxis - adult |
18 |
12 |
$228.60 |
| D0272 |
Bitewings - two radiographic images |
16 |
15 |
$150.40 |