| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
161 |
156 |
$4K |
| D0274 |
Bitewings - four radiographic images |
133 |
126 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
138 |
128 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
54 |
$2K |
| D1110 |
Prophylaxis - adult |
30 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
94 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
94 |
$939.99 |
| D0272 |
Bitewings - two radiographic images |
23 |
22 |
$491.60 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$423.84 |
| D0603 |
|
543 |
454 |
$0.00 |