| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,118 |
1,102 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,978 |
1,947 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,512 |
$26K |
| D0274 |
Bitewings - four radiographic images |
484 |
480 |
$12K |
| D1120 |
Prophylaxis - child |
371 |
366 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
41 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
39 |
$4K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$547.05 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$506.61 |