| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
334 |
331 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
308 |
$9K |
| D1110 |
Prophylaxis - adult |
128 |
127 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
77 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$1K |
| D1120 |
Prophylaxis - child |
27 |
27 |
$977.65 |
| D0274 |
Bitewings - four radiographic images |
63 |
63 |
$851.62 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$195.67 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
17 |
$0.00 |