| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
464 |
358 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
122 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
621 |
511 |
$16K |
| D1110 |
Prophylaxis - adult |
443 |
354 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
714 |
612 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
150 |
56 |
$10K |
| D2394 |
|
116 |
52 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
471 |
381 |
$7K |
| D0274 |
Bitewings - four radiographic images |
264 |
214 |
$5K |
| D1120 |
Prophylaxis - child |
237 |
182 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
430 |
349 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
85 |
67 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
25 |
$280.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
15 |
$130.00 |