| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,621 |
1,405 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,203 |
1,908 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
994 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
275 |
126 |
$15K |
| D1120 |
Prophylaxis - child |
665 |
564 |
$14K |
| D0274 |
Bitewings - four radiographic images |
470 |
401 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
110 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
623 |
439 |
$3K |
| D1206 |
Topical application of fluoride varnish |
170 |
129 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
512 |
329 |
$3K |
| D2140 |
|
58 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
93 |
72 |
$934.00 |