| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,284 |
1,208 |
$42K |
| D1110 |
Prophylaxis - adult |
268 |
256 |
$11K |
| D5120 |
|
17 |
16 |
$7K |
| D5110 |
|
12 |
12 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
131 |
120 |
$4K |
| D1120 |
Prophylaxis - child |
84 |
77 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
121 |
110 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
102 |
96 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
311 |
95 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
109 |
$1K |
| D0272 |
Bitewings - two radiographic images |
53 |
47 |
$1K |
| D1206 |
Topical application of fluoride varnish |
135 |
129 |
$22.25 |