| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,286 |
1,281 |
$34K |
| D1110 |
Prophylaxis - adult |
615 |
611 |
$27K |
| D1120 |
Prophylaxis - child |
298 |
298 |
$12K |
| D0272 |
Bitewings - two radiographic images |
429 |
429 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
147 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
140 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$1K |
| D1999 |
|
51 |
51 |
$343.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$204.00 |