| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
330 |
324 |
$16K |
| D1110 |
Prophylaxis - adult |
171 |
168 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
170 |
$11K |
| D0274 |
Bitewings - four radiographic images |
310 |
307 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
421 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
273 |
264 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
72 |
$1K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |
| D1999 |
|
113 |
83 |
$780.00 |