| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,492 |
2,492 |
$124K |
| D1120 |
Prophylaxis - child |
3,463 |
3,463 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,364 |
922 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
4,500 |
4,500 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,959 |
1,953 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,849 |
2,849 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,657 |
2,657 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
912 |
912 |
$38K |
| D0330 |
Panoramic radiographic image |
644 |
644 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,025 |
1,025 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
191 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,838 |
1,813 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
154 |
$16K |
| D2330 |
|
23 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$134.43 |