| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
493 |
484 |
$29K |
| D0274 |
Bitewings - four radiographic images |
452 |
444 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
522 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
488 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
266 |
261 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
477 |
453 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$966.00 |