| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
954 |
942 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
766 |
760 |
$15K |
| D0274 |
Bitewings - four radiographic images |
743 |
732 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
547 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
516 |
505 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
74 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
59 |
$631.79 |