| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,238 |
1,129 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,464 |
1,369 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,453 |
1,298 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
143 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,598 |
2,347 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,645 |
2,175 |
$18K |
| D1120 |
Prophylaxis - child |
532 |
506 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
487 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,137 |
1,069 |
$14K |
| D0330 |
Panoramic radiographic image |
561 |
498 |
$13K |
| D0272 |
Bitewings - two radiographic images |
287 |
270 |
$5K |
| D1351 |
Sealant - per tooth |
141 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$675.25 |
| D0602 |
|
410 |
386 |
$18.03 |
| D0601 |
|
1,422 |
1,325 |
$0.00 |
| D0603 |
|
72 |
66 |
$0.00 |