| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
573 |
254 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
636 |
636 |
$18K |
| D1110 |
Prophylaxis - adult |
359 |
359 |
$17K |
| D0274 |
Bitewings - four radiographic images |
254 |
254 |
$7K |
| D4910 |
|
86 |
86 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
196 |
195 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$3K |
| D1999 |
|
470 |
391 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
79 |
$988.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$852.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$754.00 |