| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,183 |
2,183 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,279 |
2,278 |
$53K |
| D0274 |
Bitewings - four radiographic images |
2,498 |
2,498 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,881 |
1,862 |
$39K |
| D1999 |
|
2,380 |
2,241 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
637 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
66 |
$8K |
| D1206 |
Topical application of fluoride varnish |
282 |
280 |
$6K |
| D1120 |
Prophylaxis - child |
217 |
217 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
961 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
101 |
$775.20 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
27 |
$653.80 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$642.60 |
| D0330 |
Panoramic radiographic image |
33 |
33 |
$440.64 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$156.00 |