| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
609 |
591 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
420 |
364 |
$10K |
| D0160 |
|
631 |
390 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
432 |
417 |
$5K |
| D0274 |
Bitewings - four radiographic images |
208 |
204 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
587 |
289 |
$3K |
| D1120 |
Prophylaxis - child |
84 |
75 |
$3K |
| D1110 |
Prophylaxis - adult |
131 |
123 |
$2K |
| D1351 |
Sealant - per tooth |
106 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
57 |
56 |
$935.23 |
| D1206 |
Topical application of fluoride varnish |
40 |
39 |
$816.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$345.70 |