| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,331 |
1,304 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,938 |
1,807 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,255 |
1,235 |
$28K |
| D1999 |
|
1,148 |
974 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
147 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
264 |
$6K |
| D0274 |
Bitewings - four radiographic images |
505 |
503 |
$6K |
| D0330 |
Panoramic radiographic image |
229 |
224 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
53 |
$1K |
| D1120 |
Prophylaxis - child |
38 |
38 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
108 |
$664.24 |