| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,791 |
1,663 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,480 |
2,136 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,624 |
1,483 |
$53K |
| D0330 |
Panoramic radiographic image |
1,119 |
984 |
$51K |
| D1120 |
Prophylaxis - child |
1,015 |
947 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,277 |
1,108 |
$18K |
| D0272 |
Bitewings - two radiographic images |
963 |
825 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
335 |
$14K |
| D0274 |
Bitewings - four radiographic images |
408 |
361 |
$10K |