| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
678 |
646 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
511 |
488 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
436 |
413 |
$10K |
| D0274 |
Bitewings - four radiographic images |
495 |
474 |
$7K |
| D1120 |
Prophylaxis - child |
181 |
177 |
$6K |
| D0330 |
Panoramic radiographic image |
73 |
70 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
57 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$152.16 |