| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
540 |
518 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
669 |
651 |
$18K |
| D0274 |
Bitewings - four radiographic images |
210 |
204 |
$6K |
| D1120 |
Prophylaxis - child |
168 |
165 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
252 |
247 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
97 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
15 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
41 |
$763.44 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$598.00 |