| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,126 |
3,467 |
$114K |
| D1999 |
|
4,079 |
3,471 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,846 |
2,384 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,003 |
839 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,144 |
1,810 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,421 |
1,144 |
$20K |
| D1120 |
Prophylaxis - child |
564 |
466 |
$10K |
| D2140 |
|
239 |
124 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
178 |
119 |
$6K |
| D2330 |
|
28 |
13 |
$713.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
86 |
29 |
$224.10 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
15 |
$72.70 |