| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,500 |
2,819 |
$103K |
| D1999 |
|
4,257 |
3,310 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,231 |
1,824 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,596 |
1,368 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
1,608 |
$31K |
| D0330 |
Panoramic radiographic image |
923 |
771 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
708 |
553 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
154 |
97 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
610 |
339 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
625 |
508 |
$4K |
| D1120 |
Prophylaxis - child |
145 |
122 |
$3K |
| D2140 |
|
61 |
39 |
$2K |