| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,269 |
1,267 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,943 |
1,940 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,856 |
1,854 |
$35K |
| D4910 |
|
513 |
512 |
$35K |
| D0274 |
Bitewings - four radiographic images |
607 |
606 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
442 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
79 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
280 |
278 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
926 |
914 |
$12K |
| D1120 |
Prophylaxis - child |
231 |
231 |
$9K |
| D1330 |
|
594 |
593 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
579 |
576 |
$5K |
| D0603 |
|
439 |
438 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
52 |
$2K |