| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
858 |
824 |
$17K |
| D1206 |
Topical application of fluoride varnish |
824 |
810 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
123 |
24 |
$14K |
| D1120 |
Prophylaxis - child |
552 |
525 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
157 |
55 |
$11K |
| D9420 |
|
228 |
221 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
300 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
616 |
603 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
181 |
$4K |
| D1110 |
Prophylaxis - adult |
67 |
67 |
$3K |
| D0274 |
Bitewings - four radiographic images |
108 |
108 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
231 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$542.12 |
| D1999 |
|
246 |
211 |
$320.00 |