| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
687 |
636 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
830 |
763 |
$11K |
| D1120 |
Prophylaxis - child |
211 |
200 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
26 |
$5K |
| D1110 |
Prophylaxis - adult |
158 |
133 |
$5K |
| D0330 |
Panoramic radiographic image |
30 |
25 |
$969.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
20 |
15 |
$264.00 |
| D0274 |
Bitewings - four radiographic images |
16 |
14 |
$192.00 |