| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,912 |
2,869 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
2,772 |
2,724 |
$83K |
| D0272 |
Bitewings - two radiographic images |
2,088 |
2,044 |
$63K |
| D0330 |
Panoramic radiographic image |
1,012 |
985 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
700 |
680 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,508 |
2,429 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
231 |
85 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,204 |
1,175 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,203 |
2,146 |
$27K |
| D1120 |
Prophylaxis - child |
377 |
368 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
49 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
84 |
$4K |