| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
716 |
316 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
1,781 |
1,781 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,123 |
2,122 |
$38K |
| D4910 |
|
562 |
561 |
$37K |
| D1110 |
Prophylaxis - adult |
810 |
809 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
693 |
692 |
$25K |
| D0274 |
Bitewings - four radiographic images |
905 |
904 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
387 |
387 |
$19K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$9K |
| D4342 |
|
107 |
48 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
193 |
193 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
66 |
65 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |