| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
597 |
581 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,099 |
1,067 |
$30K |
| D0272 |
Bitewings - two radiographic images |
975 |
961 |
$22K |
| D1120 |
Prophylaxis - child |
593 |
587 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,372 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,067 |
1,051 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,060 |
1,046 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
208 |
$7K |
| D1351 |
Sealant - per tooth |
119 |
36 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$847.68 |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$588.37 |
| D0602 |
|
713 |
703 |
$0.04 |
| D0601 |
|
419 |
416 |
$0.01 |
| D0603 |
|
74 |
74 |
$0.00 |