| Code | Description | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
$51K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
$39K |
| D0274 |
Bitewings - four radiographic images |
$37K |
| D0330 |
Panoramic radiographic image |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
$27K |
| D2140 |
|
$15K |