| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
421 |
291 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
322 |
$6K |
| D0274 |
Bitewings - four radiographic images |
532 |
364 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
920 |
632 |
$4K |
| D1120 |
Prophylaxis - child |
329 |
231 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
475 |
316 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
50 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,014 |
571 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
89 |
59 |
$2K |
| D1206 |
Topical application of fluoride varnish |
184 |
148 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
62 |
55 |
$1K |
| D0272 |
Bitewings - two radiographic images |
138 |
90 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
153 |
96 |
$1K |
| D1999 |
|
93 |
74 |
$0.00 |