| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
242 |
235 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
714 |
698 |
$19K |
| D1120 |
Prophylaxis - child |
401 |
392 |
$18K |
| D0274 |
Bitewings - four radiographic images |
352 |
342 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
192 |
186 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
309 |
299 |
$11K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$798.43 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$715.60 |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$392.00 |