| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,281 |
1,278 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,585 |
1,579 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
603 |
600 |
$37K |
| D0274 |
Bitewings - four radiographic images |
892 |
889 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,170 |
1,167 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
147 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,353 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,007 |
991 |
$9K |
| D1120 |
Prophylaxis - child |
219 |
219 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
91 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
38 |
38 |
$836.96 |
| D1206 |
Topical application of fluoride varnish |
43 |
43 |
$778.72 |