| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
571 |
515 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
799 |
675 |
$21K |
| D0274 |
Bitewings - four radiographic images |
659 |
574 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,386 |
1,087 |
$14K |
| D1206 |
Topical application of fluoride varnish |
458 |
433 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
689 |
595 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
268 |
256 |
$6K |
| D1120 |
Prophylaxis - child |
164 |
160 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
116 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
29 |
$3K |
| D0272 |
Bitewings - two radiographic images |
58 |
54 |
$1K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$1K |