| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2394 |
|
346 |
166 |
$31K |
| D1110 |
Prophylaxis - adult |
383 |
369 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
757 |
723 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
452 |
390 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
685 |
659 |
$11K |
| D4910 |
|
188 |
179 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
762 |
618 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
718 |
298 |
$6K |
| D0274 |
Bitewings - four radiographic images |
206 |
198 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
37 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
25 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
13 |
$2K |
| D1999 |
|
257 |
188 |
$966.00 |
| D0180 |
|
16 |
16 |
$378.00 |