| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,608 |
2,134 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,352 |
1,943 |
$32K |
| D1999 |
|
1,755 |
1,440 |
$27K |
| D0330 |
Panoramic radiographic image |
913 |
706 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,154 |
898 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
681 |
528 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
852 |
658 |
$12K |
| D1120 |
Prophylaxis - child |
368 |
305 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
70 |
46 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
131 |
$2K |
| D2140 |
|
14 |
13 |
$554.38 |
| D0220 |
Intraoral - periapical first radiographic image |
48 |
48 |
$357.36 |