| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,781 |
1,688 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,421 |
474 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
1,623 |
1,232 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,453 |
2,327 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,153 |
1,084 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,711 |
1,608 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,296 |
1,222 |
$17K |
| D1120 |
Prophylaxis - child |
744 |
701 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
246 |
51 |
$7K |
| D2335 |
|
27 |
18 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
323 |
263 |
$3K |
| D2394 |
|
12 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$518.30 |