| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,308 |
1,258 |
$45K |
| D1110 |
Prophylaxis - adult |
1,201 |
1,123 |
$31K |
| D9110 |
|
931 |
875 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,333 |
1,247 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,066 |
991 |
$14K |
| D1120 |
Prophylaxis - child |
625 |
576 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
591 |
$12K |
| D0274 |
Bitewings - four radiographic images |
429 |
405 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
129 |
$2K |
| D2140 |
|
67 |
44 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
24 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
25 |
$1K |