| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
324 |
319 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
280 |
276 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
53 |
$4K |
| D0274 |
Bitewings - four radiographic images |
139 |
138 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
71 |
71 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
149 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
30 |
$2K |
| D9110 |
|
71 |
63 |
$2K |
| D1120 |
Prophylaxis - child |
61 |
61 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
88 |
$653.00 |
| D1206 |
Topical application of fluoride varnish |
32 |
32 |
$576.00 |