| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,995 |
1,741 |
$42K |
| D0330 |
Panoramic radiographic image |
1,194 |
1,044 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,790 |
1,563 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,313 |
1,142 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,051 |
940 |
$11K |
| D1999 |
|
560 |
527 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
636 |
562 |
$8K |
| D1120 |
Prophylaxis - child |
261 |
245 |
$4K |
| D2140 |
|
21 |
13 |
$727.07 |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
80 |
$435.60 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$345.06 |