| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
711 |
709 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,170 |
1,168 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,448 |
1,444 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,222 |
1,188 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,080 |
767 |
$11K |
| D0274 |
Bitewings - four radiographic images |
307 |
307 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
186 |
$7K |
| D4341 |
|
68 |
32 |
$7K |
| D4910 |
|
71 |
71 |
$6K |
| D0603 |
|
123 |
123 |
$1K |
| D1120 |
Prophylaxis - child |
34 |
34 |
$1K |
| D0602 |
|
93 |
93 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$812.00 |
| D1999 |
|
265 |
234 |
$609.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$608.00 |
| D1330 |
|
25 |
25 |
$24.00 |