| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,615 |
2,578 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,101 |
2,090 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,800 |
1,787 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,086 |
1,084 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
560 |
$12K |
| D0330 |
Panoramic radiographic image |
274 |
272 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
309 |
307 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
732 |
698 |
$6K |
| D1120 |
Prophylaxis - child |
209 |
208 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
45 |
33 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$899.20 |
| D1354 |
|
33 |
12 |
$535.65 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
12 |
$5.20 |
| D1999 |
|
27 |
22 |
$0.00 |