| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
407 |
393 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
736 |
718 |
$18K |
| D0274 |
Bitewings - four radiographic images |
492 |
481 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
822 |
806 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
991 |
956 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
918 |
890 |
$9K |
| D1120 |
Prophylaxis - child |
214 |
209 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
35 |
$1K |
| D0272 |
Bitewings - two radiographic images |
41 |
38 |
$818.30 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$394.68 |
| D0601 |
|
879 |
848 |
$0.00 |