| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
280 |
260 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
569 |
516 |
$9K |
| D0274 |
Bitewings - four radiographic images |
418 |
389 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
38 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
26 |
$1K |
| D1206 |
Topical application of fluoride varnish |
60 |
55 |
$882.00 |
| D0140 |
Limited oral evaluation - problem focused |
36 |
30 |
$820.85 |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
84 |
$490.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
14 |
$359.71 |