| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,766 |
2,618 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
3,789 |
3,586 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,807 |
2,643 |
$71K |
| D0274 |
Bitewings - four radiographic images |
1,834 |
1,712 |
$55K |
| D1110 |
Prophylaxis - adult |
1,750 |
1,630 |
$46K |
| D0330 |
Panoramic radiographic image |
247 |
229 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
277 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
415 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
109 |
$5K |
| D0272 |
Bitewings - two radiographic images |
157 |
151 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
73 |
$879.24 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$274.34 |
| D1999 |
|
27 |
26 |
$0.00 |