| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
95 |
92 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
243 |
229 |
$3K |
| D0272 |
Bitewings - two radiographic images |
156 |
138 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
169 |
165 |
$2K |
| D1120 |
Prophylaxis - child |
74 |
74 |
$345.00 |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
18 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21 |
21 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
34 |
34 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$0.00 |