| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,018 |
1,018 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,181 |
1,180 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,177 |
1,177 |
$22K |
| D0274 |
Bitewings - four radiographic images |
522 |
522 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,008 |
953 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
767 |
667 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$6K |
| D4910 |
|
88 |
88 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
39 |
$4K |
| D0602 |
|
368 |
368 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
90 |
$3K |
| D0603 |
|
200 |
199 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
76 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$455.00 |