| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
739 |
704 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
348 |
341 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
556 |
$13K |
| D0272 |
Bitewings - two radiographic images |
865 |
814 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
501 |
466 |
$8K |
| D1120 |
Prophylaxis - child |
244 |
230 |
$7K |
| D9110 |
|
144 |
137 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
82 |
79 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
162 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$651.42 |