| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
232 |
228 |
$8K |
| D0274 |
Bitewings - four radiographic images |
264 |
260 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
80 |
$7K |
| D8670 |
Periodic orthodontic treatment visit |
52 |
52 |
$6K |
| D0330 |
Panoramic radiographic image |
129 |
128 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
226 |
221 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
45 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
278 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
94 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
100 |
100 |
$2K |
| D9110 |
|
60 |
60 |
$2K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$900.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$432.00 |