| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,660 |
3,484 |
$72K |
| D1110 |
Prophylaxis - adult |
1,958 |
1,869 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,667 |
2,516 |
$44K |
| D1120 |
Prophylaxis - child |
1,079 |
1,007 |
$32K |
| D0274 |
Bitewings - four radiographic images |
620 |
597 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
39 |
$6K |
| D0330 |
Panoramic radiographic image |
152 |
143 |
$4K |
| D0272 |
Bitewings - two radiographic images |
100 |
92 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
46 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
16 |
$698.72 |