| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,117 |
1,117 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,174 |
1,174 |
$40K |
| D4910 |
|
410 |
409 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
207 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,652 |
1,651 |
$34K |
| D4341 |
|
179 |
80 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
515 |
515 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
374 |
$23K |
| D0274 |
Bitewings - four radiographic images |
586 |
586 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,089 |
1,061 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
122 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
990 |
823 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
144 |
$6K |
| D0603 |
|
408 |
408 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$4K |
| D4342 |
|
23 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$2K |
| D0602 |
|
109 |
109 |
$1K |
| D1330 |
|
125 |
125 |
$228.00 |