| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
952 |
952 |
$27K |
| D1110 |
Prophylaxis - adult |
233 |
233 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
159 |
159 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
43 |
$4K |
| D1120 |
Prophylaxis - child |
92 |
92 |
$4K |
| D0274 |
Bitewings - four radiographic images |
111 |
111 |
$4K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
73 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
55 |
$801.30 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$444.80 |