| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,373 |
1,355 |
$62K |
| D0274 |
Bitewings - four radiographic images |
828 |
814 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,057 |
1,039 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
646 |
$22K |
| D1206 |
Topical application of fluoride varnish |
172 |
169 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$4K |
| D1120 |
Prophylaxis - child |
58 |
54 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
91 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
30 |
$425.76 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$355.61 |
| D1999 |
|
381 |
308 |
$0.00 |