| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
450 |
423 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
897 |
853 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
817 |
786 |
$12K |
| D1120 |
Prophylaxis - child |
377 |
364 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
625 |
599 |
$10K |
| D0274 |
Bitewings - four radiographic images |
297 |
290 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
557 |
530 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
13 |
$3K |
| D0603 |
|
31 |
24 |
$275.50 |